Refreezing - phase of Lewin's change theory which occurs when the plan is in

place and those involved know what is happening and what to expect.
Continuous assessment of pros and cons of the plan is an important part of the
ultimate success. New behaviors must be enforced. Someone must be
responsible for working on the plan so it doesn't lose momentum and changes
need to become a part of everyday life so it's not perceived as something new.

Why might people be resistant to change?

1) resistance- feel threatened personally that the change will lower their position
2) uncertainty- may have lack of understanding of the change
3) assimilation- unable emotionally to cope w/ change
4) transference- don't agree w/ benefits of change
5) integration- feel insecure b/c it will affect their self confidence

How do you conquer change?

1) resistance- like old way better
2) uncertainty- how is change affecting me, maybe it won't be so bad
3) assimilation- I can do this
4) transference- I like new way better
5) integration- why doesn't everyone do it this way

Who moved my cheese: the handwriting on the wall

Change happens- someone keeps moving the cheese. anticipate change- ready
for the cheese to be moved. monitor change- smell the cheese often so you
know when it's getting old, adapt to change quickly- quicker you let go of old,
cheese, sooner you get new cheese change- move w/ the cheese, enjoy change-
savor adventure and enjoy new cheese, be ready to change quickly and enjoy it
again and again- someone keeps moving the cheese

JCAHO - they conduct systematic and intensive surveys of hospitals and other
health care institutions to determine whether accepted standards of structure,
process, and outcome are being met. Founded in 1951and in 1953 their
standards were put into a book. Many 3rd party payers, such as Medicare, will
only reimburse hospitals that are accredited by them. The accreditation is good
for 3 yrs. It's not a regulatory agency but regulates standard of care. They give
an overall score or a score w/ comments for which they follow up on.

What is the mission of the JCAHO?

Enhance the quality of care provided to the public

True/false: when JCAHO comes to a health facility, they go out to the various
units to survey them.
True

1
What are the focuses of JCAHO as of 2004:
1 )improved accuracy of pt id- recommended id of patient in 2 forms other than
room number, and id of patients and area of body for surgery
2) improved effectiveness of taking orders- d/o, lab results
3) improved safety of using high alert meds- proper procedure in administering
chemo meds and meds requiring levels
4) eliminating wrong site procedures- in surgery
5) improved safety of using infusing safety pumps- pain pumps
6) improved effectiveness of clinical alarm sys and implementing regular
preventative maintenance and testing of alarm sys s/a bed alarms,
mechanism should be in place and maintenance periodically checks them
7) decrease r/f healthcare acquired infections s/a hand washing and personal
protective equipment

Quality assurance - nursing's method of monitoring and improving consumer

oriented svc. It's a process of evaluating outcomes or goals of care and ensuring
that each patient receives a predetermined high standard of care. Those
standards of care were written and adopted by JCAHO in 1980.

What is quality measured against?

Standards of those consuming the care

What must any quality improvement program focus on?

Measuring and improving nursing care to patients

Quality improvement approaches offer 3 perspectives from which to evaluate

nursing care provided:
1) structure- evaluates physical environment, organized structure, and licensure
of healthcare providers
2) process- examines what is being done for the pt and involves the pt's plan of
care
3) outcome- highlights changes in the pt's health status

Preventative medicine and preventative care - buzzwords for the future where
instead of waiting until someone is ill and needs hospitalization or emergency
treatment, emphasis will be on preventing disease and keeping people in a state
of wellness.

Incident report - an ex of a tracking mechanism put into place which determines if

there are deficiencies which the facility needs to address.

What is the performance improvement and quality assurance process:

1) set standards
2) establish criteria for achieving standards
3) determine if established criteria has been met
4) implement action plan for improvement

2
5) re evaluate standards which is an ongoing process

A hospital in Maine underwent the first audit of a healthcare facility when?

1957

Nurses began to play a more active role in quality assurance process when?
1970

Quality improvement - decreased costs and allows for predicted outcomes from
such things as surveys to pts.

Inadequate staffing - in a survey done by the ANA on 7,300 nurses about their
facility and staffing, 5,000 stated what was the major factor that declined quality
in their facility?

Government health programs, healthcare org, and healthcare managers should

make what their strategic priority?
A reduction in medical errors and improvement in patient safety

Healthcare managers - should strive to create a culture facing their institution or

organization.

Healthcare culture - defined as everyone who has a responsibility for risk

reduction and error prevention. Goes back to making sure the support staff is
educated.

True/false: it's a JCAHO requirement that health facilities routinely perform self
assessments for risk reduction and error prevention.
True

What does quality assurance and improvement affect:

1) customer service
2) other things that affect customer svc such as media, rising cost, diminishing
resources, technological complexity, ethical dilemmas, and previous exposure of
self or friends to the sys

Communication based approach - focuses on correcting weaknesses after the

deficits have been id. Ex of this is our health care sys. Based on needs.

What is an ex of community programs which are instituted thru public policies

and are based on needs?
Welfare assistance programs

Community development approach - allows individuals or organizations to id their

own strategies and issues by the building of coalitions and the assessment of the

3
competencies and strengths of communities. The decision makers are the
community leaders id by the community itself. This is an ex of empowerment.

What is the nurse's focus for the community?

To improve health of the community and build healthier lives thru health
promotion, disease prevention, and a healthier environment all done by
education, health fairs, and school and church projects

What role does the nurse play in building a healthier community?

Being knowledgeable of community needs which they learn thru establishing a
trusting presence in the community

Members and leaders of the community - this group of people, besides those
providing healthcare education, will help the community become more aware of
healthcare needs and the importance of meeting them.

Increased availability of medical info, allows for research in nursing, to keep up

with and access data, nursing documentation, accessing doctors and healthcare
facilities, schedules

***always redirect the pt back to their doctor***

What is the cause of the projected growth in home health care service?
Technological changes have made it possible to deliver service at home now.

3 ways health care can be financed:

1) self payment
2) 3rd party payment thru health insurance
3) healthcare assistance

3rd party payment - form of financing health care which is for the working
individual and is employer provided. Includes HMO's such as tricare, ppo's,
Medicare.

Medicare - most common ex of 3rd party payment which is a government

operated or public program that is federally funded and financed thru taxes on
wages. Its funding status is being threatened right now.

Who is eligible for Medicare?

Those individuals age 65 and over who are eligible for SSI, disabled individuals,
and individuals with end stage renal disease can receive this.

What does Medicare consist of?

Part A which is hospital insurance and part b which is supplementary medical
insurance that's voluntary and limited to those who have the premium deducted
from their social security check

4
Self payment - form of financing health care in which an individual or family pays
the bill for medical service

Health care assistance - form of financing health care which is a type of 3rd party
payment but is provided by the federal or state program or a private charity.

Medicaid - an ex of a health care assistance program which is a grant program

designed to provide medical assistance to the poor. It's a state and federal
partnership. Families w/ children on welfare and pregnant women are eligible.

Private charity - non profit organizations which target special health needs s/a
acquired immune deficiency syndrome or special risk groups s/a pregnant teens
along with philanthropic gifts to hospitals and various agencies, assists
individuals w/out insurance to obtain care.

How does the method of payment for healthcare service affect you as a nurse?
It's where your paycheck comes from and from where raises come

Retrospective - cost based reimbursement based on a service being provided

then being paid for after the fact. The doctor and patient has almost unlimited
autonomy in deciding what svc were needed.

Prospective - today's health care reimbursement relies on this type of payment

system that compensates the provider on an individual care basis for health care
svc. It encourages efficiency and cost containment.

Drg - an example of prospective payment system where the healthcare agency

and providers of care know in advance exactly how much they will receive for
service required to care for a patient with a particular disease. They've been
criticized for not adequately measuring the severity of illness or the diff kinds of
nursing resources used to care for patients.

HMO - an ex of prospective payment system in which the member pays a flat

fee. They're expected to obtain care at the designated facility, except in
emergency cases. The organization provides both input and output care to
families and individuals.

PPO - an ex of prospective payment system in which a group of healthcare

providers negotiated a special reduced rate to attract health plan members. If
offers individuals more freedom of choice in providers. Most operate
independently and aren't regulated by the government.

What is the challenge to nurses in regards to their role in health care financing?
Provide high quality care that is cost effective

5
assets = ?

liability and owner's equity

Severity of illness - acuity

What's owned?
Assets

What's owed?
Liability

Difference b/t budgeted and actual amts?

Variance

Plan which uses numerical data to determine expenses of a fixed income?

Budgeting process

What are 3 types of budgets:

1) operating budget - day to day supplies, usually exceeds personnel costs
2) capital - large or fixed assets or types of equipment such as IV poles, ass w/
long range planning of 3-5 yrs
3) personnel- for unit staffing, referred to as full time equivalent budget

What are the steps to budget planning:

1) determine requirements- who develops the budget, unit managers should be
included
2) develop a plan- keep in mind if facility is state funded or whether or not
operation will depend on leg decision
3) analyze and control the op- monthly ongoing analysis of computerized
statements describing expenditure
4) review plan- look at seasonal variances

Costing out - takes into account the cost of running a unit and the cost according
to the type of patients.

Transition - passage from one situation , condition or state to another over a

period of time such as with the transition from nursing school to an RN position.

4 types of transitions:
1) developmental - ex becoming a parent or midlife crisis
2) situational - ex graduation, career change, divorce
3) health/illness - ex chronic illness
4) organizational - ex change in leadership role, new staffing patterns

6
Can more than one transition occur at the same time?
Yes

What are some important factors that influence transitions:

1) whether the meaning of the transition is a positive, negative, or a neutral one
or a desired or undesired one
2) if expectation of the transition is realistic or not
3) one's level of knowledge and skill required w/ the change
4) the availability of resources w/in the environment where the change is to
occur
***knowing how to handle this period is key to a successful transition***

Transition is a change that doesn't occur automatically b/c of the attn, planning,
and determination required and how you perceive the change determines how
well you progress thru the process.
True

Reality shock - a term often used to describe the reaction experienced when one
moves into the work force after several yrs of educational prep. The new
graduate may become stressed about meeting the pt's needs as taught in
nursing school rather than also thinking about their own needs. The basis of it is
the discrepancy between the expectations of the employer and the education
prep of the graduate nurse.

What are some causative factors of reality shock:

1) unrealistic expectations of a graduate nurse
2) unrealistic expectations of others
3) time factors

Honeymoon - phase of reality shock where the grad nurse sees the world thru
rose-colored lenses", fascinated with the thrill of entering the profession. Phase
is short lived because of reality setting in. In this phase you want to be helpful to
coworkers.

Shock - phase of reality shock where there is excessive mistrust, physical

concerns s/a sleep and stress, decreased energy, feelings of failure because
trying to be perfect, there is a hypercritical attitude and moral outrage. Graduate
nurse should stick with like values.

Recovery - phase of reality shock where the graduate nurse experiences a return
of their sense of humor, there is a decrease in tension, increase in objectivity.
Conflict resolution appears. You learn and grow and develop.

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Possible methods of resolving conflict:
1) wave makers- get involved in workplace and nursing organizations, most
successful at adaptation
2) burned out- stuck in a rut resulting in griping and complaining , work for the
check, don't belong to any nursing organizations
3) org nurses- content w/ workplace but switch units or
shifts constantly to avoid increase demands for professional performance
4) job hoppers- go to grad school, seek safer and more idealistic workplace

Activities which reinforce your progress and movement along the continuum from
advanced beginner to competent nurse:
1) no more mama management- teacher should have cut cord allowing you
more independence
2) more realistic pt care assignments - taking on more than 1 pt at a time
3) increased opportunities for follow up care in the home or community setting to
obtain experience in different settings
4) clinical hours that represent realistic shift hours – being there for reports
5) perform nursing procedures instead of observing to gain experience in
unperformed or uncomfortable skills
6) more truth about the real work setting experience - talk to people who've been
there
7) look for opportunities to problem solve and practice critical thinking so you
can stand on your own 2 feet
8) request constructive feedback from staff and instructors so you can improve
your nursing care

Survival tips for role transition:

1) think positive
2) be flexible
3) get organized
4) stay healthy
5) find a mentor
6) have some fun
7) know what to expect
8) stop
9) detour
10) curve ahead
11) yield or compromise
12 )resume speed
13) exit
14) slower traffic, keep right
15) school zone
16) slow speed zone
17) caution
18) roadside park ahead

8
Mississippi Competency Model - office of nursing workforce redevelopment
developed a committee made up of members from all major nursing
organizations in MS who wrote this model whose purpose is to enhance
education and practice of MS nurses and facilitate articulation of differences in
expected skill sets based on education degrees.

What are the core competencies for the Associate Degree nurse in the provider
role:
1) care giver - plans, coordinates, implements and evaluates nursing care
designed to promote and/or maintain healthy patient outcomes
2) teacher - designs, implements and evaluates teaching plans of care for
patients
3) communicator/counselor - establishes and maintains therapeutic relationships
with patients, uses technology for the improvement of patient care
4) advocate - uses knowledge of consumer's rights and responsibilities to plan
care for and intervene on behalf of patients, is aware of health policy and its
impact on patient's care

What are the core competencies for the Associate Degree Nurse in the member
of a profession role:
1) scholar - pursues professional development as it relates to the improvement
of health care, uses interpreted nursing research findings to improve patient
outcomes
2) collaborator - participates in the establishment of collegial relationships for the
purpose of improving pt outcomes
3) ethicist - practices within the values framework and legal parameters of the
nursing profession, contributes to the decision making process relative to
ethical issues for the patient

What are the core competencies for the Associate Degree Nurse in the manager
role:
1) leader - works w/ other health care personnel to coordinate care to improve
patient outcomes, participates in implementing traditional and alternative care
delivery system, adapts practice to respond to rapid changes in health care
2) facilitator - uses knowledge of group dynamics to improve patient outcomes
3) decision maker - uses critical thinking and problem solving approaches as a
basis for nursing practice

What is the 4th role in the Mississippi Competency Model?

Knowledge expander - should be able to generate and translate knowledge by
gathering data

The nurse with a PhD is expected to be competent in all 4 roles because of prior
educational experience?
Yes

9
What are the competencies we must meet in regards to professional behavior?
1) practicing within legal, ethical, and regulatory frameworks of nursing
2) exhibits responsible work ethics
3) assumes accountability for nursing care given by self and/or delegated to
others
4) participates in professional development
5) participates in community svc activities

What are the competencies we must meet in regards to communication:

1) communicate effectively with individuals, families, groups, and health care
team members
2) document completely and accurately

What is the main competency we must meet in regards to assessment?

Make accurate comprehensive assessments related to patient needs

What are the competencies we must meet in regards to clinical decision making
1) use critical thinking and nursing process skills to make valid, rational,
justifiable clinical decisions
2) use evidence based info to support clinical decision making

What are the competencies we must meet in regards to caring interventions:

1) provide safe, accurate nursing care in diverse settings
2) incorporate community resources, environmental factors, cx and values in the
provision of patient care
3) integrate age specific competencies in caring for patients across the lifespan

What is the main competency we must meet in regards to caring?

Demonstrate caring behaviors toward the patient, significant support persons,
peers, and other members of the healthcare team

What is the main competency we must meet in regards to teaching/learning?

Develop, implement, and evaluate teaching plans based on assessed needs for
individuals, families, and groups

What are the competencies we must meet in regards to collaboration:

1) function as a productive member of the health care team to achieve patient
and org outcomes
2) utilize directions and feedback from others to achieve patient and
organization outcomes

What are the competencies we must meet in regards to managing care:

1) set priorities of patient care
2) delegate patient care to qualified personnel appropriately
3) manage care for groups of patients
4) practice in a cost efficient manner

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5) demonstrate adaptability in relation to changes in the clinical environment
6) demonstrate competence with current technologies
7) manage time effectively

How is power developed?

By the development of a powerful image and using personal power strategies or
tools

What are the key factors in developing a powerful image:

1) self confidence
2) body language
3) self image
4) grooming and dress
5) speech
6) attitude, beliefs, and values
7) career commitment
8) continuing professional education

What are some examples of personal power strategies or tools:

1) good communications skills
2) networking
3) mentoring
4) goal setting
5) developing an expertise
6) high visibility
7) organizational savvy
8) collaboration and collegiality
9) coalition building
10) negotiation skills
11) empowering attitude

****Some other things that one can use to develop power are accepting
responsibility, being a risk taker, winning and losing gradually, being comfortable
with conflict and ambiguity, taking constructive criticism gracefully, and always
following thru on promises****

Politics - simply a process of human interaction within an organization.

Why should nurses have to know about politics and be involved in the political
process?
1) Because politics is in every aspect of life such as work, organizations, family,
profession
2) to influence public policy
3) help id needed resources and gain access to them

11
What are the levels of political activism related to professional involvement in
nursing?

1) apathetics - uninvolved
2) spectators- pay dues but very little involvement
3) transitionals - actively involved, mostly local organizations
4) gladiators- take on leadership roles on national level

Influence - the process of using power or using power to influence the behavior
of others.

What is the nurse's involvement in the political process:

Knowing the candidates, campaign involvement, volunteering help, contributing
to health care knowledge, be on political action committees (pac's)

Ana's pac - thru this, the nurses across the country organized to collectively
endorse and support candidates for national and state offices. They must
comply with the state or federal election codes and report financial support given
to candidates for public office.

Lobbying - form of influence which attempts to sway a public official to take a

desired action. It educates officials. This can be done personally or in writing.
It's a flood on key issues. Once decision is made, follow up with a thank you.

How can we as nurses lobby?

1) meeting candidates and evaluate them as potential office holder
2) offering knowledge in writing or in person when the official needs to know how
to vote on an issue
3) maintain contact between legislative sessions and during holidays when
they're in their home district

What are some controversial issues affecting nursing:

1) uniform core licensure
2) collective bargaining such as unions
3) equal pay

What is the NCLEX test plan based on?

1) Nursing process- each of the 5 phases such as assessment, diagnosis,
planning, implementing, evaluating
2) areas of patient needs such as safe, effective care environment (23%), health
promotion and maintenance (10%), psychosocial integrity (15%),
physiological integrity (52%)

When can breaks be taken while taking the NCLEX?

10 min break required after 2 hours of testing

12
What do you do if you have to change your scheduled date or time to take your
NCLEX test?
Contact them before noon, 2 business days before testing day - if you don't,
they'll charge you another test fee

****6 months before taking the NCLEX, make sure you know deadlines and
application process for your state, investigate review courses, and plan an
expense account for the end of school and for the NCLEX****

****2 months before taking the NCLEX, If you have a job, discuss your test date
with them, decide how you're going to get to the test and if overnight stay is
necessary, decide if you'll go alone, and develop a study plan****

****The day before taking the NCLEX, make sure you have all the required
paperwork, drive the route to the test, and get lots of sleep****

****The day of the test eat a good breakfast, dress comfortably, and arrive at the
test site a little early****

****Some important things to assess when deciding on an NCLEX test review

course are determining credentials of teacher, cost, time length, location, and
deciding on a good NCLEX book****

****Some tips for getting rid of test anxiety related to the NCLEX test: Plan
ahead to study and set aside the time, think positively, take breaks about every
hour, and don't cram****

****Strategies for answering multiple choice questions include reading stem

carefully, creating pool of info, evaluating all options, eliminate obvious wrong
answers, id similarities in options, evaluate priority questions carefully, and select
the answer that focuses on the patient****

Difference in career and job?

Career progresses throughout professional life while job is specific task or work
agreed to do and doesn't suggest lifetime work

What are the career styles or paths:

1) steady state- person has long history in same area and has gained
competence
2) linear style- starts in 1 area and climbs up such as staff nurses to charge
nurses
3) entrepreneurial- nurse practitioner who starts own business or the nurse who
does continuing education, more flexible
4) transient- job hopper

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5) spiral- starts full time for several yrs then takes a break and comes back full
time

How long should you stay in a job?

At least 1 yr

What is involved in career planning?

1) Self analysis- determine what's important to you
2) maintain competence thru continuing education and certification in your area
2) setting career goals both short and long term
3) planning for employment w/ a resume and interview

When seeking employment, some things to take into consideration:

1) job responsibilities
2) salary
3) location of the facility
4) benefit package

What are some professional expectations on graduate nurses:

1) privileges and obligations
2) nurse practice act and other legal expectations
3) joining professional organizations
4) participating in community svc
5) reporting incompetent practice

What is the key to making the right career choice?

Thru self evaluation you determine who you are and what you like

What should you set career goals?

1) each time you succeed in meeting a goal you increase self confidence
2) they're a roadmap to give you direction to where you want to go
3) no matter the goal, it always help to have a plan

charge position - this position in nursing may involve responsibility for a particular
staff or day or may involve managing an entire unit

Entry level position - this position in nursing is usually staff nurse positions.

****Take time to reinforce your nursing competencies, it will prepare you for your
future practice in nursing****

Networking - contacting everyone you know and even some you don't to get info
about a specific organization or institution.

14
Self management - deciding what you want for yourself, setting goals for your
life, developing objectives and short term outcomes to reach the goals, and
finally organizing the time and activities so that you can achieve the goals.

Self care - it's at the core of self management. It requires a foundation that will
assist you in thriving in nursing rather than just surviving.

What are some potential threats to one's health and well being:
1) stress
2) lack of time
3) substance
4) inability to meet holistic self care needs such as emotional, mental, physical,
spiritual, social choices
5) communicable diseases such as HIV and work related injuries s/a back injury

What are some sources of stress in nurses?

1) expectations
2) change
3) people you work with
4) position

How can nurses manage stress?

1) primary prevention for mild stress - modify stress by exercise, music,
relaxation techniques
2) secondary prevention for high levels of stress – get help

Lack of time - there is a close relationship w/ b/t this and stress. You must utilize
effective time management because good time management leads to stress
prevention and stress reduction.

How can nurses avoid communicable disease and work related injuries?
1) use universal precautions, follow OSHA guidelines, wear protective clothing,
and follow post exposure guidelines
2) use proper body mechanics

What can, as a nurse, do if you have a substance abuse problem?

Don't ignore it, get involved in a treatment program and rehab

****Things that contribute to stress include rotating schedules, physical job

demands, too tired to sleep, neglecting physical health, long hours with no
recuperation time, and no social activities****

Self care leads to what?

Empowerment

15
When trying to take care of self, what's the 1st thing you should do?
Do a self assessment of one's well being and self esteem

You have to do what in order to take care of self?

Know self

Emotional wholeness - ability to feel and know what we are feeling, expressing
one's emotions is a sign of good mental health.

Mental wholeness - ability to dream and fantasize, remove negative and self
defeating thoughts, give self daily affirmation, and tell self you are special and
worthy of self love and love of others.

Social wholeness - tends to over commit personally and professionally, needs to

engage in recreational activities; leaves money in budget for fun; forms
relationships outside of nursing, such as friends in other major areas of study;
maintains humor.

Physical wholeness - tends to neglect physical health. Noncompliant. Needs

proper nutrition, adequate sleep, and exercise.

Spiritual wholeness - doesn't necessarily deal with religion. It involves feelings of

being alive, purposeful and fulfilled; involves daily prayer and meditation and
read spiritual and/or philosophical material.

****To assess choice potential: realize you have choices on how to respond and
react, be proactive rather than reactive, make things happen rather than waiting
for them to happen, act responsibly toward self and others, and give yourself self
love and self acceptance****

Burnout - occurs when working in environment not congruent with personal

philosophies, person tends to be a perfectionist, overly unselfish, passive. It's
due to internal or external factors. You may have change jobs.

What are some local trends affecting healthcare?

1) nursing shortage
2) agency nurses
3) terrorism
4) legislature such as low interest home loans, scholarships

Who plays a role in changing trends in healthcare?

1) politics
2) government
3) technology
4) consumer

16
Graying of America - trend in healthcare which has to do with the aging
population that we will be caring for as well as those in the field of nursing that
are aging.

How is graying of America going to affect nurses now?

1) caring for people w/ multi system and chronic problems, need for long term
care facilities will increase, sponging because the aging don't generate much
money back into the system but need healthcare
2) decrease enrollment in nursing schools
3) by 2010 there will be a nursing shortage of 1 million
4) working conditions don't meet expectations and working demand
5) aging nurses and nurse faculty b/c average age of nurse
is 42y/o and average age of nurses faculty is 48 y/o
6) task force addresses incentives for going into nursing

What kind of technological advances are occurring which will affect healthcare?
New nursing care delivery system with alternate sources of treatment such as
relaxation tech, computers being utilized in every aspect of healthcare,
transmitting patient info to places such as clinics

Globalization - describes the spread of a common culture around the world with a
universal sharing of attitudes, products, industry, and stocks. 3rd world countries
will see developmental growth and make a greater contribution to the global
market. Religions and cultures will blend together. Nurses will care for the world
as one global economy.

How will nurses be affected by globalization?

We will need to learn about beliefs and practices of other cultures, you may see
different disease processes because of traveling to other countries, will work with
migrant workers

What are some changes occurring in healthcare info?

Being shared via internet, the public is more informed, there is an increased
demand for preventive care

What are some examples of alternative health care?

Consumers make on choices regarding health care and the use of
unconventional healing alternatives (seen in 25-49 y/o females)

****We are in a more facilitating role, we have more freedom and responsibility,
we are now expected to analytically think, be creative, understand technology, be
technical, be productive, and provide adequate safe quality we must be
prepared, allowed, and required to participate in counsel where goals and
service of patients are delineated and evaluated****

17
What are some changes that have been occurring in health care delivery
systems?
1) managed care strategies by insurance companies such as HMO's
2) health promotion/risk reduction screening to encourage wellness and patient
self management
3) restructuring of hospitals or downsizing to reduce cost
4) large organizations merging entities such as Baptist Health Systems

What determines the structural make up of the organization?

Services provided and philosophy of the institution

What is the difference in a centralized and a decentralized organization:

In centralized organizations, nursing care is delivered from a central authority
and in decentralized orgs, there's increased decision making by subordinates

Corporatization - taking place to achieve large economies scale with low costs.

The emphasis in health care has been and continues to be on what kind of a shift
and how does the shift affect nursing?
From non profit to for profit so nurses must be not only patient centered but also
experts in business side of health care

Integrated health care delivery system - individual health care organizations that
merge into system to provide all needed service under 1 corporate umbrella.
They offer preventive services such as wellness programs, acute and long term
care facilities, home health, and hospice services. They may own the individual
entities or contract with them to provide specialty services.

Organizational charts - communicative pattern of organization which are maps

that determine who report to whom. They describe the relationship to the chief
nursing officer to id patterns of communication or chain of command.

Participative management - communicative pattern of organization which give

input and advice about issues but make no decisions.

Shared government - communicative pattern of organization in which some

aspects of the management of the unit are shared with the staff.

Self governed - communicative pattern of organization which makes staff nurses

fully accountable for running the unit.

Unions - communicative pattern of organization in which staff don't speak directly

to organization, but they choose someone to represent them.

Clinical ladder - rewards clinical expertise or professional accomplishments such

as precepting a student.

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Functional Nursing - type of nursing where RN's were employed by hospitals
during World War II, shortage of nurses which caused a nursing shortage and the
roles of LPN's and NA's were developed to perform simple functions such as
med administration and treatments. The nursing care was fragmented and
delivered in a series of tasks by many people which made it impersonal.

Team nursing - Type of nursing where groups of patients are assigned to a team
headed by a team leader, usually an RN, who coordinates the care for a
designated group of patients. The leader determines work assignments for the
team on the basis of the acuity level of the patients and the ability of individual
team members. It's composed of an RN, 2 LPN's, and 2 NA’s. Good
communication is essential.

Primary nursing - type of nursing where the nurse plans and directs the care of a
patient over a 24hr period eliminating the fragmentation between shifts.
Progress reports, referrals, and discharge planning are responsibilities of the
primary nurses. This type of nursing led to an all RN staff and put the RN back at
the bedside.

Patient focused care - type of nursing where functions are centralized on the unit
under the direction of the RN to cross trained ancillary workers to perform more
than one function which increase their levels of productivity. The patient comes
into contact with fewer people and gets to know those caring for them better.
The RN is more accountable due to overseeing a range of svc delivered to the
patient.

Case Management - strategy to ensure coordination of care while reducing costs

for patients with complex health care needs. It's a collaborative process that
assesses, plans, implements, coordinates, monitors, and evaluates options and
service to meet a person's healthcare needs. They must be skilled at critical
thinking, negotiating, and collaboration and must be knowledgeable about
resources available to patients.

Who may be a case manager?

RN, social workers, and therapists who all practice within their scope

Clinical pathway - tools used by the case manager which support the work of the
case manager and help reduce expensive variations in care. They're also known
as care maps or collaborative plans of care. They're interventions for patients
with a particular disease, procedure, or symptom.

Patient outcomes - term associated with clinical pathways which are a list of
outcomes expected by the time of discharge.

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Timelines - term associated with clinical pathways which are specific timing for
the sequence of health care interventions.

Collaboration - term associated with clinical pathways which are a joint effort by
multiple healthcare professionals.

Comprehensive aspect of care - term associated with clinical pathways which are
a component that tracks the primary health care intervention such as diagnosis,
treatment, or meds.

Disease management protocols - Integrated system of interventions,

measurements, and refinements of health care delivery designed to optimize
clinical and economic outcomes within a specific population. Focuses on
prevention and education activities when patient isn't in acute stage of disease so
they'll be prepared to manage symptoms. Also outlines standard interventions to
be implemented during the acute stage of disease. Nurses involved are
employed thru health plans.

Patient classification or acuity system - JCAHO requires that staffing be based on

an organized system such as this one which estimates the intensity of nursing
care required to meet patient needs. Based on budgeted hrs/pt/day.

****Some important aspects of scheduling patterns are no matter the situation,

someone must be in charge, and the shift must be covered and must achieve
delivery of quality care in an economical manner****

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