question

Community Health Nursing

answer

blend of primary health care and nursing practice with public health nursing

question

primary goal of community health nursing

answer

raise level of health for citizens promote physical/ mental health prevent disease, injury, disability

question

home health care

answer

enable individuals of all ages to remain in the comfor and security of their homes while reiciving health care

question

services of home health care

answer

skilled nursing physical therapy psychiatric therapy pain education/managment speech language therapy occupational therapy social services intravenous therapy acquistition of medical supplies/ equipment home health aide homemaker petcare assistance companion care respiratory therapy nutritional support

question

goal of home health care

answer

allow as much independent as possible

question

4 perspectives of home health care

answer

1. official 2. patient 3. family 4. provider

question

OFFICIAL home health care

answer

services in home to promote, maintain, restore health minimize effect of illness/ disability

question

PATIENT home health care

answer

one on one health care provider in home basic care/ individualized needs on personalized schedule over a period of time = adjustment, change, learning takes place effectively

question

FAMILY home health care

answer

family together as functioning unit goals: learning to adapt to change, prevent dysfunction, family wellness, emotional support, community support

question

PROVIDER home health care

answer

provide excellent care in less than excellent surroundings goal: independence, creativity, communication, clinical skills, daily practices

question

Earliest organized home health care

answer

1617 st. vincent de paul sisterhood of the dames of charite met social welfare and visiting nursing needs

question

Boston Dispensary

answer

1796 1st home care program in US

question

1886

answer

1st visiting nurse service in US Philadelphia

question

Lillian Wald & Mary Brewster

answer

1893 visiting nurse service for the poor NYC Nurses Settlement House on Henry Street

question

Social Security Act of 1935

answer

1st provided government rather than local charitable funding for select services such as maternal health, treatment for communicable diseases, training of public health professionals

question

medicare became effective in ?

answer

1996 revolutionized home care

question

medicare revolutionized home care by

answer

1. changing it to a medical rather than nursing model of practice 2. defining and limiting the services it reimbursed 3. changing the payment source and even changing the reason for providing home care

question

Prospective Payment System (PPS)

answer

1983 part of the Tax Equity and Fiscal Responsibility Act for hospitals receiving Medicare reimbursement

question

Diagnosis-Related Groups (DRGs)

answer

pays a set rate accordig to diagnosis for the hospitalized patient's care rather than the "cost" or charges and instituion traditionally bills according to its own schedule of fees - discharge for such patients occured earlier and patient required more nursing care

question

Types of Home Care Agencies

answer

1. licensure by state 2. certification by state 3. certificate of need 4. accreditation by an outside agency

question

Licensure by state

answer

gives legal permission to operate w/i state only

question

Certification by state

answer

federal gov. set the rules governing certificates

question

Certificate of need

answer

some states grant according to rules and formulas that state regulator devise

question

Accredidation by outside agency

answer

evaluates and judges how well the agency meets certain standsards that the accrediting organization sets (NLN community health accreditation program)

question

Before Medicare agencies classified by

answer

Visiting nurse associations, state and local health departments, nursing divisions, hospitals controlled provision of home health care

question

Agencies classified according to

answer

1. tax status - profit or non 2. location - freestanding or institution 3. governance - private or public

question

Joint Commission (TJC)

answer

looking for agencies to establish ethics committees to handle ethical issues that arise in the home

question

Changes to Home Health Care

answer

1. psychiatric patients are required to be under the care of psychiatrist & have diagnosis 2. social workers taking more active role 3. nurse pain specialists 4. agencies obtaining separate medicare certification for hospice care 5.pet-care programs to reduce patient stress 6. electronic home visits 7. telemonitoring 8. home infusion therapy 9. home IV therapy

question

Types of Home Care Agencies

answer

1. Voluntary 2. official 3. comvination 4. hospital 5. proprietary 6. private not for profit 7. other

question

State licensing boards & Professional organizations dictate what?

answer

functions and scopes of practice including: skilled nursing, physical therapy, speech-language therapy, occupational therapy, medical social services, homemaker-home health aide

question

RNs provide what?

answer

direct skilled nursing services

question

LVNs provide what?

answer

basic nursing services under the supervision of the RN needed skills: self-direction, motivation, creativity, clinical proficiency, flexibility, compassion, empathy, patience

question

Service Goals of Skilled Nursing

answer

1. Restorative 2. improvement 3. maintenance 4. promotion

question

Restorative

answer

return to previous level of function as appropriate/ realistic

question

Improvement

answer

achieving better health and highter level of function than at admission

question

maintenance

answer

preserving functional capacities and independence by maintaining current level of health

question

Promotion

answer

teaching healthy lifestyles that keep the effect of illness or disaibility to a minimum and prevent the recurrence of illness

question

Skills of home health nurse

answer

1. technically proficiency 2. self motivated 3. independent decision maker 4. respond prompltly to problems 5. able to adapt to family/patient/ home enviroment

question

LVN home health duties

answer

catheter care ostomy care wound care/ sterile dressing obtaining specimen injections prefilling insulin fingersticks for blood glucose monitor physical status set up/ monitor meds including IV nutrition therapeutic diet teaching/reinforcement respiratory care, ventalation tracheostomy care and suctioning enemas pain management emotional support preventative health measures vital signs patient / family teaching

question

physical therapy

answer

licensed / qualified physical therapist is required, PT assistant goals: restorative and maintanance rehab plan taught to patient/ family to promote self care

question

Speech Language Therapist

answer

to be reimbursed by medicare: masters prepared physician certified by american speech/ hearing association range from: language relearning eating swallowing disorders lipreading

question

Occupational therapist

answer

bachelor's level preparation registered choose / teach theraputic activities to restore funtional levels: promote independance analysis of activities relating to patients' skin disease management lifestyle design , fabricate, fit, orthotic or self help devices improve performance of activities of daily living, sensory-motor, cognitive, and neuromuscular function

question

Medical social services

answer

focus on emotional and social aspects of illness care plan includes: edu counseling payment source identification referrals coping w/ stress and crisis intervention

question

Homemaker- Home Health Aide

answer

Provide basic support services medicare requires that a primary skilled or therapy service (speech or physical) be provided before HHA services are arranged

question

3 categories of aide services

answer

1. personal 2. physical assistance 3. household chores

question

medicare / medicaid requirments of home health aide

answer

onsite supervision every 2 weeks by RN services provided in blocks of time ranging from 1-2 hours

question

Home Health Process

answer

1. referral 2. admission 3. care plan 4. visits 5. documentation 6. discharge planning (by case manager)

question

Referral

answer

comes from patient, family, social service, hospital, physician, other agency

question

Admission

answer

RN makes the initial eval and admission vist within 24-48 hours of the referreal 1. evaluation 2. enviromental assess. 3. i.d. of impairments 4. i.d. of impact of disease/ disability 5. assess support system 6. determine knowledge/adherence of treatment/ meds 7. involvment of patient/ fam in care plan 8. determin desire for care/ services 9. notify patient of rights 10. explain rights of self determination 11. initial nursing interventions (every 60 days)

question

Care Plan

answer

from physician -describes current physical status, meds, treatments, disciplines, duration, goals, outcomes, time frame

question

Visits

answer

to serve / meet patients- centered goals

question

Documentation

answer

concise and complete doc. to provide accurate info of type and quality of care linked to legal implications

question

Discharge planning

answer

done by case manager begins with admission and ends when patient goals or other specific criteria are met

question

Quality Assurance, Assessment, & Improvement

answer

provide doc for evaluating specific criteria dn measures in each area & evaluate them for compliance and effectiveness -reflect standards, objectives, measureable outcomes, include plans for remediation or improvement 1. structural criteria 2. process criteria 3. outcome criteria

question

Structural Criteria

answer

agencies overall practices

question

Process criteria

answer

eval of care delivery

question

Outcome criteria

answer

Measurement of change

question

Medicare

answer

agency required to be certified meet federal conditions of : organization staffing training services covered agency eval 65 OR OLDER, DISABLED, END STAGE RENAL DISEASE

question

Medicaid

answer

pays for home care services for LOW INCOME PPL OF ALL AGES state administers, federal subsidized

question

Third Party

answer

pay for limited home care services payment rates vary posthospitalization recoveries tied to reimbursment

question

Private Pay

answer

directly pay for home health services charges range

question

HMOs

answer

prefered provider organization prepaid based on prevention

question

PPOs

answer

negotiated contracts with home health agencies

question

Nursing Process of LVN in home helth care

answer

Plan care for patients based on needs Review patients care plan / recommend provisions Review / follow defined prioritization of patient care Use clinical pathways, care maps, care plans to guide/ review patient care

question

NURSING PROCESS

answer

assessment analysis/ nursing diagnosis planning implementing evaluation

question

Take aways

answer

- current trends support growth of home care as an economic, humane, preferred health delivery system -medical management and control rather than cure are the standards of care for illness -home care provides assessment and eval of chronic illnesses and is helpful for preventation in future -aide and homemakers can provide necessary support in ADLs to enable patient to remain @ home -skilled nursing and therapy offer rehab and prevention of deterioration, and methods to cope with physical changes

question

Long-Term care

answer

defined by ANA as provison of physical, psychological, spiritual, social, economic services to help ppl attain, maintain, regain their optimum level of functioning -range of services: health maintenance care, to ppl who have lost ability to function independantly due to chronic illness or condition

question

need for long term care

answer

acute stage of an illness has resolved, patient continues to need services to support and maintain physical and psychological status and functional abilities

question

Patient-centered approach

answer

achieve/ maintain an individualized plan of carre to assist patient in preserving meaningful quality of life

question

quality of life

answer

measure of optimum energy/ force that endows a person with the power to cope successfully with full range of challenges he or she encounters in the real world

question

Hospice

answer

services to patients/families as end of life approaches. available to any age-group -maintain comfort as death approaches

question

pallative care

answer

broader pop. having ability to benefit from comfort care earlier in their illness or disease process. provides care for -basic needs (ADLs) -ADLs -pain and symptoms management -spiritual/ psychosocial support

question

Adult DayCare

answer

community-based programs to meet needs of functionally or cognitibely impaired through supervised health and social/ recreational activities provide: -physical care -mental stimulation -socialization -assistance w/ maintanance -health referrals (during any part of the day, but for less than 24 hours)

question

Assisted Living

answer

residential care rental of small apartment serveral personal care services: -bathing, dressing, medications (choice, autonomy, independance w/ supervision) -communal dining and various social activities

question

HOME

answer

least restrictive

question

INSTITUTIONAL

answer

most restrictive

question

Institutional settings

answer

1. subacute unit 2. long-term care facility

question

subacute unit

answer

not limited by reimbursment less expensive alt. to acute care when patient has high acuity medical and nursing intervention needs -bridge between acute care and long-term care -located in free standing skilled nursing facilities

question

Long-Term care facility

answer

dominant form -24-hour care to individuals who do not require expensive inpatient hospital services but who do not have options for care at home or by other community agencies -long or short term basis -resident rather than patient -most residents have more than one health disorder

question

short term resident

answer

6 months

question

long term resident

answer

duration of life

question

long-term interdisciplinary care team

answer

professionals work togethre as an interdisciplinary team to meet the needs of older adults

question

restorative nursing care

answer

basic concepts of physical therapy for maintenance of functional mobility and physical activity

question

omnibus budget reconciliation Act (OBRA)

answer

nursing home reform legislation defines requirements for the quality of care given to residents

question

Health Care Financing Administration (HCFA)

answer

administers and monitors the OBRA guidelines through institutional surveys

question

Medicare

answer

federally funded national health insurance program in US for ppl older than age 65

question

Applications of the Omnibus budget reconciliation act of 1987

answer

1. resident rights - fully informed resident / participates in own health care plan 2. physical restraints - no restraints for discipline/ convinence 3. resident assessment - assessment is foundation of planning and delivery of care 4. licensed nursing services - 24-hours a day 5. registered nurses - 8 hrs a day 7 days a week 6. nursing assistants - trained and competency tested

question

Ethical Issues for Long term care

answer

-adherence to patients bill of rights - advance directives -DNR orders -Power of attorney -guardianship -responsible party designation

question

Functional Nursing

answer

each has a function adn reports back to head nurse

question

Team nursing

answer

all work together toward common goal

question

residential assessment instrument (RAI)

answer

three parts 1. MDS 2. RAPs 3. Utilization guidelines

question

Minimum Data Set (MDS)

answer

provides a system for assessment of each residents functional, medical, mental, psychosocial status

question

Resident Assessment Protocol (RAPs)

answer

assessment guides that adress common clinical problems -delirium, falls, urinary incontinence

question

Utilization Guidelines

answer

wealth of clinical info to assist in assessment and care planning

question

OBRA guideline for functional assessment docs

answer

diff from acute care setting vital signs/ weights required monthly

question

Nursing process for LVN in long term care

answer

1. assessment -review plan of care every 90 days 2. Nursing diagnosis- id from assessment, prioritieze risk 3. Expected Outcomes/ planning 4. evaluation

Community Health, Home Health Nursing & long term care – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards