Nurs 221 Midterm Study Guide
Nurs 221 Midterm Study Guide NURS 221
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This 10 page Study Guide was uploaded by Lindsay Mirrione on Saturday August 20, 2016. The Study Guide belongs to NURS 221 at San Diego State University taught by Daugherty in Spring 2016. Since its upload, it has received 7 views. For similar materials see Professional Formations A in NURSING at San Diego State University.
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Date Created: 08/20/16
NURS221 Exam 1_Study Guide: From weeks 1 & 2, know the how healthcare funding was covered prior to implementation Affordable Care Act. (2013 was the example year in the slides)—Examples: who were the major payors? Who are the stakeholders? How does U.S. healthcare compare to other nations? The major payors were health insurance (private, medicare, medicaid) The stakeholders were the public, the employers, the providers (MDs, NPs, PAs, PharmDs), Hospitals, Governments, alternative therapies, Insurers (Blue Cross, Kaiser, Medicare, etc.), longterm care/ assisted living/ memory care, mental health, education and training programs, professional associations, other health industries (durable medical equipment), researchers US healthcare is not competing with other industrialized nations, frequently ranking lowest among comparable countries, yet spending is more than most countries Know the purpose and general timeframe of various legislative acts to improve public health. Such as the Social Security Act, Children’s Health Insurance Program, components of Medicare and Medicaid as described in class and the slides. Social Security Act (1935) Federal OldAge benefits, and to assist states to make more adequate provision for aged persons, blind persons, dependent and crippled children, maternal and child welfare, public health, and the administration of their unemployment compensation laws. Medicare/ Medicaid (1965) Both were amendments to the Social Security Act, so were easier to pass than introducing a new law. Medicare Part A (hospital coverage) and Part B (insurance) in the original plan covered people 65+. In 1972 Medicare was expanded to include the disabled and end stage renal disease. Medicaid was medical insurance for people on state public assistance, expanded to include families, the disabled, pregnant women, and people needing long term care regardless of age. People meeting the requirements for both programs are “dually eligible” Part C (2003) allowed private insurance companies to offer Medicare Advantage Programs to fill the gaps between Parts A and B. Part D (2006) allowed coverage for pharmaceutical costs Childrens Health Insurance Program (CHIP) Coverage for uninsured children whose parents earned too much to qualify for Medicaid (11 million children) federal and state funded Affordable Care Act (2010) Health Insurance Marketplace as single source for uninsured to find affordable health insurance. Reorganized healthcare to be less hospitalfocused and more patientcentered and preventionfocused (1 million insured + plus 11+ million more Medicaid and CHIP enrollees) lowest level of uninsured people in the US since the early 1970s more than 5.7 million young adults now qualify for coverage under parents health plans rate of uninsured adults dropped more than 40% since 2009 expanded preventative services to all insured preexisting condition exclusions now illegal decreased prescription drug costs for older adults and disabled Know general timelines of historical trends in HealthCare and Nursing. For example, don’t need to know a specific year but know the decade of events outlined in slide sets. Examples: How did the healthcare advances from 19002000 compare to 20002010? How did the training and work of nurses shift from the time of Florence Nightingale to today? Health care advances of 19002000 clean water reduced deaths from fecal and other contamination that caused typhoid fever and cholera public health regulation of food safety reduced food born contamination such as salmonella antiseptic techniques early vaccinations (polio, smallpox, mumps, measles, rubella) anesthesia antibiotics Health Care advances of 20002010 vaccine preventable diseases meningicoccal, herpes zoster, pneumococcal, HPV, tetanus, diptheria, pertussis prevention and control TB, central line blood stream infections, HIV, west nile virus, rabies tobacco control from 1965 (42%) 2009 (20%) maternal/infant health screenings, folic acid, prenatal care have reduced neural tube defects by 36% and increased birth weight motor vehicle and road safety cardiovascular disease prevention and early treatment occupational safety Nursingthen to now historically Herbal healers, religious healers usually all men ancient egyptians among first to classify drugs and organize health system middle ages: religious orders care for the sick in hospes (root word for hospital and hospice) Hospitals are usually places people go to die not to get well crusades: a religious military order, the Knights Hospitalers During 1700s, nursing schools begin to develop Florence Nightingale volunteered to nurse soldiers during the Crimean War Nightingale made it her mission to improve hygiene practices, significantly lowering the death rate at the hospital in the process. Her work reduced the Crimean hospital’s death rate by twothirds her observations on health and hygiene not only make her a revolutionary leader in nursing, she is one of the earliest “epidemiologists.” She used statistical methods for data tracking and analysis at night, she made rounds carrying a lamp, ministering to patient after patient. The soldiers took to calling her “the Lady with the Lamp.” How did nursing get here? ● nurses began as independent practitioners, but without standardized education or practice. Quality varied. ● nurses joined registries, where the registry vouched for the quality of the care provided. Education varied. ● during the Great Depression, hospitals offered room, board, and a small stipend in exchange for work, which led to the formation of hospitalbased nursing education and practice. ● postWWII (19451960) medical care moved into hospitals, decreasing the role of primary care providers ● nursing education moved to universities in the 19401970 time period. ● development of Associate Degree programs prepare “technical nurses” ● nursing develops its research and practice base (19702010) ● role of Nurse Practitioner develops (19701990) ● research demonstrates that higher education is linked to provision of better quality care and better patient outcomes ● Institute of Medicine Report on the Future of Nursing calls for transition to BSN education for all RNs and for expansion of PhD and DNP programs For the Nurse Practice Act/Business and Professional Code, know the key concepts highlighted on the slides for the provisions. Be able to recognize a given scenario as an application or a violation of the practice act Business and Professions Code of California 2725: Legislative intent; Practice of nursing defined (a) In amending this section at the 197374 session, the Legislature recognizes that nursing is a dynamic field, the practice of which is continually evolving to include more sophisticated patient care activities it is the intent of the Legislature in amending this section at the 197374 session to provide clear legal authority for functions and procedures that have common acceptance and usage it is the legislative intent also to recognize the existence of overlapping functions between physicians and registered nurses and to permit additional sharing of functions within organized health care systems that provide for collaboration between physicians and registered nurses. these organized health care systems include, but are not limited to, health facilities licensed pursuant to Chapter 2 (commencing with section 1250) of division 2 of the Health and Safety Code, clinics, home health agencies, physicians offices, and public or community health services (b) The practice of nursing within the meaning of this chapter means those functions, including basic health care, that help people cope with difficulties in daily living that are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill, including all of the following: (1) direct and indirect patient care services that ensure the safety, comfort, and personal hygiene, and protection of patients; and the performance of disease prevention and restorative measures (2) direct and indirect patient care services, including, but not limited to, the administration of medications and therapeutic agents, necessary to implement a treatment, disease prevention, or rehabilitative regimen ordered by and within the scope of licensure of a physician, dentist, podiatrist, or clinical psychologist, as defined by Section 1316.5 of the Health and Safety Code (3) the performance of skin tests, immunization techniques, and the withdrawal of human blood from veins and arteries (4) observation of signs and symptoms of illness, reactions to treatment, general behavior, or general physical condition, and (a) determination of whether the signs, symptoms, reactions, behavior, or general appearance exhibit abnormal characteristics, and (b) implementation, based on observed abnormalities, of appropriate reporting, or referral, or standardized procedures, or changes in treatment regimen in accordance with standardized procedures, or the initiation of emergency procedures (c) “standardized procedures,” as used in this section, means either of the following (1) policies and protocols developed by a health facility licensed pursuant to Chapter 2 (commencing with section 1250) of Division 2 of the Health and Safety Code through collaboration among administrators and health professionals including physicians and nurses (2) policies and protocols developed through collaboration among administrators and health professionals, including physicians and nurses, by an organized health care system which is not a health facility licensed pursuant to Chapter 2 (commencing with section 1250) of Division 2 of the Health and Safety Code. The policies and protocols shall be subject to any guidelines for standardized procedures that the Division of Licensing of the Medical Board of California and the Board of Registered Nursing may jointly promulgate. If promulgated, the guidelines shall be administered by the Board of Registered Nursing. (d) Nothing in this section shall be construed to require approval of standardized procedures by the Division of Licensing of the Medical Board of California, or by the Board of Registered Nursing. (e) No state agency other than the board may define or interpret the practice of nursing for those licensed pursuant to the provisions of this chapter, or develop standardized procedures or protocols pursuant to this chapter, unless so authorized by this chapter, or specifically required under state or federal statute. “State agency” includes every state office, officer, department, division, bureau, board, authority, and commission. 2725.1: Dispensation of drugs or devices by registered nurse; Construction (a) Notwithstanding any other provision of law, a registered nurse may dispense drugs or devices upon an order by a licensed physician and surgeon or an order by a certified nursemidwife, nurse practitioner, or physician assistant issued pursuant to Section 2746.51, 2836.1, or 3502.1, respectively, if the registered nurse is functioning within a licensed primary care clinic as defined in subdivision (a) of Section 1204 of, or within a clinic as defined in subdivision (b), (c), (h), or (i) of Section 1206 of the Health and Safety Code (b) No clinic shall employ a registered nurse to perform dispensing duties exclusively. No registered nurse shall dispense drugs in a pharmacy, keep a pharmacy, open shop, or drugstore for the retailing of drugs or poisons. No registered nurse shall compound drugs. Dispensing of drugs by a registered nurse, except a certified nursemidwife who functions pursuant to a standardized procedure or protocol described in Section 2746.51 or a nurse practitioner who functions pursuant to a standardized procedure described in Section 2836.1, or protocol, shall not include substances included in the California Uniform Controlled Substances Act (Division 10 [commencing with Section 11000] of the Health and Safety Code). Nothing in this section shall exempt a clinic from the provisions of Article 13 (commencing with section 4180) of Chapter 9. 2725.3: Functions performed by unlicensed personnel (a) A health facility licensed pursuant to subdivision (a), (b), or (f), of Section 1250 of the Health and Safety Code shall not assign unlicensed personnel to perform nursing functions in lieu of a registered nurse and may not allow unlicensed personnel to perform functions under the direct clinical supervision of a registered nurse that require a substantial amount of scientific knowledge and technical skills, including, but not limited to, any of the following: (i) Administration of medication (ii) Venipuncture or intravenous therapy (iii) Parenteral or tube feedings (iv) Invasive procedures including inserting nasogastric tubes, inserting catheters, or tracheal suctioning (v) Assessment of patient condition (vi) Educating patient and their families concerning the patient’s health care problems, including postdischarge care (vii) Moderate complexity laboratory tests (b) This section shall not preclude any person from performing any act or function that he or she is authorized to perform pursuant to Division 2 (commencing with Section 500) or pursuant to existing statute or regulation as of July 1, 1999 2729: Services by students nursing services may be rendered by a student when these services are incidental to the course of study of one of the following: (a) a student enrolled in a boardapproved prelicensure program or school of nursing (b) a nurse licensed in another state or county taking a boardapproved continuing education course or postlicensure course For the ANA Code of Ethics, know the key concepts highlighted on the slides and be able to recognize a given scenario as an ethical or unethical action based on the provisions. Provision 1: the nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person 1.1: respect for human dignity health care as a right respect for the values of others leadership in public and health policy change 1.2: relationships with patients trust, need for care, free from bias and prejudice promote health respect patient decisions’ obligation to protect patient 1.3: the nature of health respect patient regardless of health assist patient in achieving the highest levels of ability possible avoid unnecessary or risky treatments 1.4: the right to selfdetermination moral and legal right to make own decisions right to accurate, complete, and understandable information to make informed decisions right to accept or reject any treatment without duress or prejudice 1.5: relationships with colleagues and others respect for others, including fair treatment, civility, and respectful compromise create civil and kind work environment Provision 2: the nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population 2.1: primacy of the patient’s interests nurse’s primary commitment is to the patient attempt to resolve conflicts with patient’s wishes as guide 2.2: conflict of interest for nurses nurses deal with competing loyalties, conflicting expectations, and personal vs. professional values. Nurses address these conflicts in ways that ensure patient safety and promote the patient’s best interests while preserving professional integrity. 2.3: collaboration develop mutual trust and shared decisionmaking help patients secure information and that is understood interdependence of nursing roles with shared outcomes in nursing care and commitment to patient 2.4: professional boundaries the work of nursing is inherently personal accept no gifts from patients no dating or sexual intimacy with patients boundary violations with professional colleagues can also occur and must be guarded against Provision 3: the nurse promotes, advocates for, and protects the rights, health, and safety of the patient 3.1: protection of the rights of privacy and confidentiality limit intrusion into a person’s life physical as well as personal privacy privacy of personal conversations policies that protect the rights and privacy of patients nondisclosure of personal information 3.2: protection of human participants in research patients have the right to choose to participate in research and to opt out at any point in the research process informed consent special rights of vulnerable groups may not withhold treatment or coerce people to participate 3.3: performance standards and review mechanisms continual improvement to maintain competence educational excellence nurses individually, collectively, and as a profession are responsible and accountable for practice and professional behavior 3.4: professional responsibility in promoting a culture of safety nurses participate in the development, implementation, review and adherence to policies that promote patient health and safety when errors occur, they must be reported and disclosed to patients causes of errors need to be explored to eliminate recurrence 3.5: protection of patient health and safety by acting on questionable practice nurses must take action in all instances of incompetent, unethical, illegal, or impaired practice or actions that place the patient in jeopardy must report to internal and external authorities risk to the nurse does not eliminate obligation to report to protect patient 3.6: patient protection and impaired practice when an individual’s practice seems to be impaired, it is the nurse’s duty to take action to protect patients and to ensure that the impaired individual receives assistance protection of the patient first and the professional second Provision 4: the nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care 4.1: authority, accountability, and responsibility nurses are responsible and accountable for their own practice scope of practice continues to evolve, yet nurses must be aware of their scope 4.2: accountable for nursing judgments, decisions, and actions fidelity, loyalty, beneficence, and respect for the dignity, worth, and selfdetermination of patients systems and technologies that assist in clinical practice are adjunct to, not replacements for, the nurse’s knowledge and skill 4.3: responsibility for nursing judgments, decisions, and actions nurses are always accountable for their judgments, decisions, and actions, which may be borne by both the nurse and the institution nurses accept or reject assignment and role demands based on education, knowledge, competence, and experience, as well as assessment of risk for patient safety maintain standards of practice assess own competence 4.4: assignment and delegation of nursing activities or tasks nurses are responsible for all delegated nursing activities nurses assess individual competence when delegating activities nurses provide safe environment for employees nurses promote open communications nurses serve as educators and preceptors in sharing responsibility and accountability for student actions Provision 5: the nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth 5.1: duties to self and others 5.2: promotion of personal health, safety, and wellbeing nurses should model behavior we expect of others selfassessment of fatigue and effectiveness 5.3: preservation of wholeness of character integration of personal and professional selves provides unbiased information to patients be aware of conflicts of belief and values 5.4: preservation of integrity reflection and discernment of own integrity abuse of all kinds must be reported nurses must be treated with respect by others 5.5: maintenance of competence and continuation of professional growth nurses are responsible for continuing their formal and informal professional growth 5.6: continuation of personal growth nurses are responsible for continuing their formal and informal personal growth
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