Exam 1 Study Guide
THIS IS NOT INTENDED TO BE COMPREHENSIVE. THERE MAY BE
OMMISSIONS OR ERRORS.
Differentiate between medicaid and medicare
Medicaid is for the poor, Medicare is for the old.
Diagnosis Related Groups
DRGs are a way for hospitals to move from cost-based billing to service-based
billing. Initiated as a way to control costs.
DRGs are based upon the patient's
Principal diagnosis,
ICD diagnoses,
Gender,
Age,
Sex,
Treatment procedure,
Discharge status, and the presence of
Complications or comorbidities.
There are more than 400 DRGs and different DRG systems.
Differentiate between HMO, PPO
Health Maintenance Organizations (HMO) usually only pay for care within the
network. You choose a primary care doctor who coordinates most of your care.
HMO controls meds ordered, test performed, # of physician visits, # of days in
the hospital (HMOs, usually need a referral from primary physician to see a
specialist
Preferred Provider Organizations (PPO)-a list of providers that participate in the
insurance must be used for reimbursement or the client pays out of pocket
expense. They usually pay more if you get care within the network, but they still
pay a portion if you go outside
Components of critical thinking
The process of actively and skillfully:
Conceptualizing
Applying,
Analyzing,
Synthesizing, and/or
Evaluating
Information gathered from, or generated by,
Observation,
Experience,
Reflection,
Reasoning, or
Communication,
as a guide to belief and action.
In its exemplary form, it is based on
Clarity,
Accuracy,
Precision,
Consistency,
Relevance,
Sound evidence,
Good reasons,
Depth,
Breadth, and
Fairness.
American Nurses Association (ANA)
Established in 1911
The “Voice of Nursing”
Established a Code of Professional Nursing
Established credentialing for specialty areas
Lobbies for Nursing
National League of Nursing (NLN)
Founded in 1893 as American Society of Superintendents of Training
Schools for Nurses
Promotes
Faculty development,
Networking opportunities,
Testing services,
Nursing research grants, and
Public policy initiatives
After the Goldmark report the NLN began to develop standards for schools
to follow.
After the Brown report the NLN began to accredit nursing schools for
quality and structure of programs.
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 populations (ANA)
Goldmark Report (1923)
In 1920 the Rockefeller Foundation funded the Committee for the Study of
Nursing Education, which included Annie W. Goodrich, M. Adelaide Nutting, and
Lillian Wald, to study nursing education in the United States.
The report concluded that the quality of existing nursing programs was
inadequate. As a result of the report, the Rockefeller Foundation funded an
experiment in nursing education, which became the Yale School of Nursing. The
Yale School of Nursing was the first autonomous school of nursing with its own
dean, faculty, budget, and degree meeting the standards of the University.
Education took precedence over service to a hospital, with training based on an
educational plan rather than on service needs.
The Brown Report (Nursing for the Future) (1948)
Authored by Esther Lucille Brown in 1948 and sponsored by the Russell Sage
Foundation, was critical of the quality and structure of nursing schools in the
United States. The Brown Report became the catalyst for the implementation of
educational nursing program accreditation through the National League for
Nursing
Hill-Burton Act (The Hospital Survey and Construction Act) (1948) (Truman)
Designed to provide federal grants and guaranteed loans to improve the physical
plant of the nation’s hospital system.
Facilities that received Hill-Burton funding had to adhere to several requirements
No discrimination
Required to provide a ‘reasonable volume’ of free care each year
Prove the economic viability of the facility
Participate in Medicare and Medicaid
Nursing in the Middle Ages and Christian Period
Whores, witchcraft, men in the Crusades, church institutions. Blah, Blah, Blah.
Florence Nightingale (Mother of Nursing)(1820-1910)
Upper class, educated British woman who cared fro soldiers in the
Crimean War
Had a holistic and preventative approach to nursing but did not believe in
theories of contagion or germs
Opened schools of nurses
Collected data -- groundwork for evidenced-based practice
Requirements of nursing licensure
According to the National Council of State Boards of Nursing:
You must provide verification of completion and eligibility for graduation,
from a state-approved nursing program.
You must pass the NCLEX® examination.
You must self-report any and all criminal convictions, chemical
dependencies, and functional ability deficits.
Differentiation of Nursing Roles. A Nurse is a:
Provider of care
Educator
Counselor
Manager
Researcher
Collaborator
Change agent (intrapreneur)
Entrepreneur
Patient advocate
Steps For the Development of Public Policy
Define the problem
Specify criteria
Identify solution options & select the best
Implement the policy
Monitor & evaluate the policy
Public health in the early 1900s…was crap.
Policies that have affected healthcare
Particularly related to Money: Medicare, Medicaid, S-CHIP, ObamaCare
Also Renal Disease Program (1972)
Role of theory in nursing
A nursing theory is a set of concepts, definitions, relationships, and assumptions
or propositions derived from nursing models or from other disciplines and project
a purposive, systematic view of phenomena by designing specific interrelationships among concepts for the purposes of describing, explaining,
predicting, and or prescribing.
The benefits of having a defined body of theory in nursing include better patient
care, enhanced professional status for nurses, improved communication between
nurses, and guidance for research and education (Nolan 1996).
Nursing schools used to base their education on one theorist but now many
individuals and schools use more than one theorist to guide their practice and
provide framework for their institutions.
Culture and governing by health care organizations (HCOs)
Hospitals and large Health Care Organizations are set up as bureaucratic
organizations that must remain financially viable.
Bureaucratic organizations:
Utilize a division of labor
Have a defined hierarchy
Have detailed rules and regulations
Which can lead to impersonal relationships: staff will do only the work
they are expected to do
All of which can detract from effective healthcare and a healing environment
Reimbursement rules from the Centers for Medicare and Medicaid Services
(CMS) play a significant role in patient treatment (what can be paid for is more
likely to be performed). Multi-State health insurance companies can have the
same power.
What else?