NCLEX PN Study Guide Module 1 | Coordinated Care Of the Patient

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Table of Contents

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This section of the NCLEX-PN study Guide covers a variety of topics, beginning with the rights and responsibilities of patients.

Medical facility patients’ rights and responsibilities

nurse taking care of patient in hospital

Patients should understand their rights as well as their responsibilities in medical facilities.

Rights: Every patient should be able to access high-quality medical care without being excluded. Nevertheless, patients can decline medical treatments if they so desire. Furthermore, patients should be informed about specific treatment plans that are advocated for them, as well as their overall privacy.
Responsibilities: Patients also have a role to play as part of their overall responsibilities. This includes providing their complete health history. As well as acting with respect towards others, they should always treat them with dignity.

Informed consent must be provided by patients/guardians

Treatment must be thoroughly explained to patients beforehand, and informed consent must be obtained before proceeding.

Whenever possible, any risks or complications associated with the treatment must be included in the information provided to the patient.

As outlined by the American Medical Association, the following guidelines can be followed to obtain consent from the patient:

Explaining the diagnosis
A description of the treatment procedures and their rationale
If there are any risks associated with treatment, they must be highlighted
Alternative treatments available to the patient
The benefits and risks of these alternative treatments

Patients may opt out of informed consent, which should always be documented, even though informed consent is a state requirement.

Nevertheless, whatever procedure was to be carried out should proceed.

Informed consent is not required when performing procedures that will save their life.

Confidentiality of patients

It is a considerable responsibility of nurses and patients to maintain confidentiality in their relationships.

Patient information should always remain private.

It’s possible on rare occasions to break patient confidentiality if it’s necessary to save their life.

It is imperative that the paper records of patients are kept in a secure environment at all times and this also includes their digital records

Behavioral ethics principles

Here are a few ethical principles you need to know:

Autonomy

In order for patients to have autonomy when it comes to their care, they need to be empowered to make their own decisions.

When this is not possible, such as with children or patients with dementia, a parent, legal guardian, or another family member can make the decision on their behalf.

Justice

Health care benefits should be allocated fairly to a society based on this ethical principle.

Beneficence

According to this principle, we should act in ways that benefit others.

In other words, the ultimate goal of treating a patient is to give them the best treatment possible.

Although this is true, a patient’s condition changes constantly, so treatment measures should always be reevaluated to ensure they are still effective.

Nonmaleficence

In accordance with this ethical principle, healthcare workers should not harm patients.

Code of ethics: Nursing staff

Advances in extending the lives of patients, prenatal manipulation, and saving premature babies have brought healthcare ethics to the forefront.

The limited resources in healthcare can lead to many ethical dilemmas, however.

There are several statements in the American Nurses Association’s Code of Ethics that nurses should consider when faced with moral or ethical dilemmas

In challenging situations, they can use an ethical decision-making model.

Following are general guidelines for using them:

A thorough analysis of the problem is conducted and the problem is pinpointed
Alternatives or solutions to the problem should be considered
Ethics committees can provide guidance and should be considered where available
Think of possible solutions and try them out
Decide on a solution to the problem

A person’s autonomy, beneficence, nonmaleficence, justice, and fidelity should be considered when making ethical decisions.

Professional boundaries

In hospitals, patients, and staff can form bonds over time.

To show their appreciation, patients often give gifts to medical staff.

While medical personnel should not accept money or valuables from patients, a small gift, such as a box of chocolates, is fine.

The nurse should inform the patient that the facility does not allow it if they persist.

It is also prohibited to cross boundaries that lead to sexual relations.

By paying more attention to their patients, nurses providing home care may be at a disadvantage.

Only duties that are outlined in your job description should be performed.

When you cook or buy groceries for a patient, you may make them rely on the nurse too much, even if you are just helping out.

It is possible to be accused of favoritism in a hospital setting when a patient receives too much attention from you.

During the discussion of personal boundaries, it is also necessary to address coercion.

Nursing should not attempt to influence a patient’s decision through coercion or intimidation, no matter what their relationship with you is.

Finally, let’s discuss the disclosure of personal informationFinally, let’s discuss the disclosure of personal information.

You should never reveal personal information to patients.

As a result, their professional roles blur, and a social relationship develops, which in turn makes both parties vulnerable.

Collaboration and coordination related to patient care

Collaboration skills

In every medical facility, medical staff works together to coordinate patient care.

It is essential to have the following skills when it comes to collaboration:

Having the ability to compromise
Communicate clearly
Identifying relevant problems/challenges
Pay attention to what needs to be done
Teamwork

Communicating effectively and developing the necessary skills to do so

It is necessary to use a variety of communication skills when collaborating, which are not the same as those that are used when dealing with patients.

The following are some of them:

Adopting an assertive approach: Being honest and non-threatening while expressing your opinions clearly is key
Talking casually: Having a personal bond with someone makes it easier to discuss things. Building bonds within a team can be enhanced by casual conversations with other staff members
Public speaking competence: You need to be confident enough to share your ideas with others. Public speaking skills can be extremely helpful in this situation
Written communication: It’s also a vital skill to be able to communicate ideas in writing

Hand-offs

During shift changes, there is a transition of care, and that’s what this refers to.

For this, a standardized format is available:

DRAW: Diagnosis, recent and anticipated changes, what to look out for
I PASS the BATON: Introduction, patient, assessment, situation, safety considerations, background actions, timing, ownership
ANTICipate: Administrative dates, new clinical information, tasks, illness magnitude, contingency measures
5 Rs: Record, review, round up, relay to others, receive feedback

SBAR method

When a caregiver hands off a patient to another, this is the format used.

Situation: This is an overview of the current situation of the patient
Background: History of the patient and their condition
Assessment: Facts and conditions summarized
Recommendations: Future actions that need to be carried out

Shift reporting

Whenever possible, this includes handing off at the bedside on shift changeovers by using a specific format.

The shift report must include the following information:

The patient is introduced to the new staff member(s)
Patient triage/acuity level
Potential/confirmed diagnosis
Current status
Pending/completed laboratory imaging
Medications administered/pending
Invasive treatments (catheter, for example)
Plans for transfer/discharge

Nurse and patient/family collaboration

In addition to collaborating with the patient, the nurse also collaborates with their family.

Unfortunately, this is often overlooked.

It is important to consider both the patient and their family when planning to help improve the health of someone in a medical facility.

Styles of leadership

The style of leadership can have an impact on how values are perceived and how collaboration is viewed.

Apart from mentioning them by name, we won’t go into great detail about them.

Your coursework can provide further information about these leadership styles

The following are examples of leadership styles:

Charismatic
Bureaucratic
Autocratic
Consultative
Participatory
Democratic
Laissez-faire (free reign)

Conflict resolution

Conflicts can arise occasionally between members of a team when working together.

Some form of conflict resolution must be implemented when they do occur.

Managing conflicts effectively allows people to express different viewpoints on a subject, which shouldn’t be considered negative.

Conflicts should be resolved as soon as possible, especially before hardening attitudes develop.

Following a process can help resolve conflict:

There should be a presentation from both sides regarding their views. Views, not the people expressing them, are the key here
Cooperation should be fostered through compromise and negotiation
It is important to maintain focus in order to avoid arguments and keep discussions on track
Assess whether further negotiations are necessary, whether a formal resolution process is required, or whether a third party should be involved
Use humor or empathy to resolve potentially explosive situations
A summary of key arguments should be provided for each issue
Avoid forcing resolutions, if possible

Members of the healthcare team

A healthcare team consists of a variety of units.

Nursing care is often designed to support patients.

As a result, this support is in line with therapies prescribed by other disciplines working in the facility.

A nurse works within a team that includes:

Physicians
Therapists (occupational and respiratory are examples)
Case managers
Social workers
Nutritional services
Housekeeping
Discharge planners

As described above, let’s examine specific parts of the team.

As a first step, we begin with occupational therapy.

The goal of occupational therapy is to achieve functional outcomes that enhance a patient’s health, decrease their risk of future injuries, and maximize their independence.

Occupational therapists implement various strategies to meet the needs of patients in order to improve their basic motor and cognitive skills.

Next is respiratory therapy.

Respiratory therapists work with patients with cardiopulmonary or respiratory disorders.

Diagnostics, evaluations, and treatment are the three main objectives of their work.

Various activities are carried out to achieve this, but we won’t go into too much detail here since you can refer to your course notes.

Finally, we have the case manager.

The case manager is an RN who manages the care provided to insured patients and they work for a health insurer.

In whatever illness the patient suffers from, they are experts.

It is important to provide the patient with quality, cost-effective treatment with the goal of preventing any complications and the patient returning to the hospital.

Pathways (both evidence-based and clinical) and tracking patient progress are used to accomplish this.

Assessing the need for patient referrals

Considering the following issues when referring a patient is important:

The necessity thereof
Insurance requirements
What specialist/therapist will be used?
Submission

Delegation

Nurses should assess patients’ needs before delegating any tasks.

Always consider the following five delegation rights:

Right task: Based on the patient’s needs, a nurse can delegate a task that is appropriate
Right circumstances: Nurses must consider various factors when deciding whether delegation is appropriate. These include setting, resources, time, safety, and more
Right person: Delegating tasks requires the selection of the right person based on the task
Right direction: Staff assigned to perform the task must be given the right direction and understand what the expected results are.
Right supervision: Supervision should be conducted and intervention is taken, where necessary

Models: Healthcare delivery system

Let’s take a look at different healthcare delivery models.

Primary nursing model

In this model, the same nurse is responsible for the entire period of care, ensuring continuity thereof.

So therefore, a primary nurse is responsible for providing care to the patient over a 24-hour period so as to meet the individual needs of each patient.

This model is rarely used due to its cost-prohibitive nature.

Case management model

In this model, the focus is not only on the quality of care but also its cost.

Using this model, the treatment of patients is monitored by a case management team.

Among all the models, this is the most cost-effective.

Family-centered model

Families provide insight into the patient’s needs and abilities by participating in this process.

By using this model, the family can assist healthcare workers in making informed decisions about services and support.

The result is a significant increase in patient satisfaction.

Public health nursing model

This module focuses on public health care.

It covers a broad range of health issues that occur in the entire population.

With this model, prevention is addressed at all levels, starting with primary prevention, but also not bypassing secondary and tertiary prevention.

Integrative model

As part of this model, also known as the interdisciplinary model of care, a team of healthcare professionals cooperates.

It is in this setting that information is shared in order to develop a comprehensive treatment plan that addresses not only a patient’s medical needs but also their psychological and social needs.

Within this model, nurses will be joined by physicians, social workers, psychologists, and therapists.

Medical home model

Providing primary and comprehensive care, this approach aims to improve relationships between the patient and various groups linked to them, for example, those treating them, as well as their families.

A focus is placed on the patient and their coordinated care, as well as safety and quality thereof.

Chronic care model

These evidence-based, population-based, and patient-centered models are used to manage chronic diseases proactively.

This model aims to provide better medical care at multiple levels.

These include community, organizational, provider, and patient levels.

Evidence and excellence are more important than autonomy in this model.

Systems for delivering healthcare

A coordinated approach to healthcare delivery fosters efficiency.

Management strategies are also used to control the use of healthcare services.

The government and employers both contribute to the financing of these systems.

The healthcare providers prescribed by a managed care delivery system will have to be used by subscribers.

In this type of system, health care is provided at the following levels:

Acute care: Short-term hospital care. This could be for injuries or episodic illness
Long-term care: Trauma patients
Custodial care: Assistance at home by people who do not require specialized training or skills
Intermediate care: Includes custodial care, but with nursing supervision added
Sub-acute care: Despite the fact that these patients are stable, they need active care. Someone who requires extensive wound care would be an example. Patients undergoing rehabilitation or residents of nursing homes would also be included here.

From your coursework, you should also cover transitional hospitals, telehealth, and community-based nursing.

Nursing as a process

Nursing processes are covered in this section.

A nurse’s assessment and its purpose

Nursing assessment is an ongoing process that evaluates data and can be carried out in collaboration with others to assist in diagnosis and treatment.

A patient’s medical history as well as their baseline health are also taken into account to ensure their safety.

The following are always included in nursing assessments:

Baseline information
Information regarding how a patient responds
Intervention recovery
A patient’s health is maintained through continued efforts

The purpose of nursing diagnosis and planning

The comfort and outcome of the patient are the primary focus of nursing diagnosis.

A nursing intervention is established here to ensure a patient’s comfort and safety.

As well as any foreseeable potential interventions, this is in terms of the direct therapies that are necessary.

Likewise, planning is an important consideration, since it helps nurses outline how they will achieve a patient’s goals.

In this plan, which should always be documented, there will be priorities, alternative therapies, and expectations for the patient’s discharge.

Nursing plan: Implementation

Nursing plans must be implemented with a certain amount of fluidity.

Due to the fact that new data will likely need to be accumulated, the original plan will likely have to be revised.

Throughout the process, the individual needs of the patient must be considered.

Nurses can provide the right interventions based on the response of the patient to the plan.

It is important to document everything in case further treatment for the individual is required at some point in the future.

As a result of documentation, current treatment regimes can also be adjusted and improved.

The process of evaluation

As part of patient care, processes need to be continuously evaluated.

Essentially, all procedures and interventions are evaluated based on various standards, quality of care, and patient outcomes.

As deficiencies are rectified through critical evaluation, patient care will improve.

The evaluation process is heavily dependent on keeping adequate documentation.

Planning: Nursing care

An individual’s overall health needs should be determined by nursing diagnoses in collaboration with their family and the patient.

This includes:

Critical needs: These will be met immediately. Other patient needs are also ranked based on Maslow’s Hierarchy of Needs and their own priorities.
Desirable outcomes: These are defined for each patient diagnosis and follow once they are prioritized. This could include behavioral changes patients have to make. Outcomes also help determine if objectives are being met via the nursing care a patient receives.
Goals: Both the patient and family will have input here and these are drawn up for every nursing diagnosis. These goals can be short-term, intermediate-term, or long-term which work together along a treatment timetable.

The defined goals are achieved through a detailed list of actions.

Among these actions are nursing interventions as well as coordination with other healthcare workers.

Study your coursework for the exam to learn more about nursing care plans.

Care planning resources

Various resources provide information about nursing diagnoses, interventions, and expected outcomes.

They include those from:

The North American Nursing Diagnosis Association (NANDA)
Nursing-Sensitive Outcomes Classification (NOC)
Nursing Intervention Classification (NIC)

Each of these three uses the Taxonomy of Nursing Practice to classify diagnoses, outcomes, and interventions.

The following four domains are used to classify patients:

The functional domain
The physiological domain
The psychosocial domain
The environmental domain

As this is something you can study in your coursework, we won’t go into too much detail.

Care planning: Utilizing clinical pathways

A clinical pathway describes how to treat a defined patient group according to written guidelines.

Evidence-based guidelines are used to prescribe standardized medical and nursing care.

As a result, care costs can be predicted more accurately, and the overall quality of care can be assured in an efficient manner.

There are typically several components to these plans:

A DRG or group of patients that the plan is aimed at
Time segments
Certain activities that must be carried out in each time segment
The intended outcome of each segment

Care is provided in accordance with the plan’s pathway.

However, nurses have an additional responsibility.

Besides helping to formulate the patient’s pathway, they also help to modify it when necessary.

As the nurse monitors the patient’s progress using the pathway, she will make sure the patient receives the correct care at each time segment.

Incorporating patient and family rights into care plans

It is easy for both patients and family members to participate in their overall care plan if it is designed as a collaborative effort.

They can participate in a variety of useful programs, including advisory committees, to assist with the process.

Healthcare workers can gain insight into what affects these groups and other issues by conducting surveys of patients and their families.

Psychosocial factors affecting care planning

Psychosocial factors, such as the patient’s emotional state, can influence their care plan.

The way they deal with others, including those who treat them, is heavily influenced by that.

In addition, it can affect a patient’s overall compliance as well as their health outcomes.

The care plan must address any psychosocial factors that appear.

Cultural and social influences can also affect a patient’s perception of their health and what might be wrong with them.

These can include:

Ethnicity
Race
Gender
Religion
Age
Sexual orientation
Family dynamics
Socioeconomic status
Life experience

Care planning and comorbidities

It is possible for patients to have multiple chronic medical conditions that require intricate medical or surgical management as part of their care plan.

Nursing plan implementation

The nursing care plan for an individual will be implemented once the patient has been stabilized.

The medical team then follows this plan to determine what further interventions need to be performed.

Here are some points to note:

Performing planned nursing interventions is the nurse’s responsibility. It may be possible to delegate and coordinate some of these tasks to meet the patient’s needs
Documentation of both the care given and the patient’s overall response is essential
As a patient’s condition, priorities, and needs change, the care plan is continually modified
Orders are analyzed, clarified, and questioned (if necessary) to meet collaborative patient needs
This process relies heavily on patient input, especially when it comes to the overall evaluation of the plan
The care plan determines treatment based on lab test results

Transcription and terminology

Here are some nursing abbreviations you should know:

ADL – activities of daily living
BMP – basic metabolic panel
CBC – complete blood count
CNS – central nervous system
DOE – dyspnea on exertion
ESRD – end-stage renal disease
GI – gastrointestinal
h – hours
HA – headache
MI – myocardial infarction
MOA – mechanism of action
N/V/D – nausea, vomiting, and diarrhea
ORIF – open reduction internal fixation
RBC – red blood cell
ROM – range of motion
S&S – signs and symptoms
SOB – shortness of breath
URI – upper respiratory infection
US – ultrasound
UTI – urinary tract infection
WBC – white blood cells

Orders: Verbal

Telephone orders, or orders given verbally, carry a risk.

When more than one order is given, the risk is that the person receiving it will misinterpret it, misunderstand it, or even forget the specifics thereof.

The National Patient Safety Goals recommend that any orders given in this manner are written down and then read back to the person giving them before confirmation is given that they understand the order.

Client information: Recording and communicating

Information about the client will be recorded in a variety of documents.

This includes:

Medical records
Referral forms
Transfer forms
A variety of report forms

All of these are covered in your coursework for the exam, but we won’t go into great detail about them.

Legal regulations

Let’s get right to it since there is quite a bit to cover.

Advance directives

These are permitted under both federal and state law.

Typically, they are in the form of living wills, but they may also include the right to appoint someone to make decisions on the patient’s behalf through a power of attorney.

In a healthcare setting, this facilitates individuals’ rights to self-determination

A healthcare provider should ask patients if they have any specific requests if they don’t have any advanced directive documents.

Regulation: Nurse practice act

Nurses are regulated by each state’s nurse practice act.

Nursing education, their roles, and responsibilities, as well as their authorization to carry out their duties, are all included here.

In addition, it provides a list of the steps that an RN can take when determining advanced practice education, responsibilities, limitations, and experience.

Through this act, a registered nurse’s delegation and supervision responsibilities are also regulated.

Nursing care accountability

Nurses are responsible for patient outcomes as members of an interdisciplinary team as stipulated in state nurse practice laws, in the practice guidelines of the ANA, and in their overall job descriptions.

Nurses fulfill this responsibility through various tools at their disposal, such as a nursing care plan.

In accordance with the act, nurses have the responsibility to highlight factors in an individual’s treatment that can enhance outcomes and should maintain detailed records.

Additionally, nurses are responsible for ethical and moral conduct, especially when it comes to delegating and supervising tasks.

Nurses should also always strive to enhance their overall knowledge throughout their careers.

HIPAA

Patient health information is protected by the Health Insurance Portability and Accountability Act (HIPAA).

Furthermore, it governs how the patient’s information is collected, shared, and their rights are affected.

Patient privacy is protected by HIPAA.

Physically and technically protecting patient information is the responsibility of the medical facility.

A consent form should be signed by the patient if any information is to be shared with a third party.

OSHA

Healthcare workers are protected by the Occupational Safety and Health Act (OSHA).

Their employers provide a safe work environment by providing proper gear and notifying them of potential hazards.

Commitment to OSHA compliance reduces the risk of injuries and illnesses among its employees.

OBRA 1990 (PSDA)

Patient Self Determination Act 1990 is one of the components of the Omnibus Budget Reconciliation Act.

Patients must be informed of their right to accept or reject advanced healthcare directives.

Patients’ advance directives describe the medical interventions they would like to have performed if they become incapacitated.

Another option is to nominate a family member to make these decisions on behalf of the patient.

The PSDA also allows patients to refuse medical treatment.

While we won’t go into detail here, make sure you read through your coursework about the Emergency Medical Treatment and Active Labor Act (EMTALA) as well as the Centers for Medicare and Medicaid (CMS).

Research: Nursing

This section will discuss various research elements, including:

Variable: An entity that can be distinct from others within a population
Independent variable: In order to evaluate its effect this is the variable that researchers change
Dependent variable: Because of changes to the independent variable, this variable may change as a result
Hypothesis: A proposed explanation for a study’s expected outcome
Sample: The population that’s been selected for the study
Experimental group: Population receiving treatment/invention within the sample
Control group: Population not receiving treatment/intervention within the sample

Basic research ideas should be understood by all nurses, including:

Survey of valid sources
Internal/external validity evaluation
Sample selection
Sample size

Validity, generalizability, and replication are also important considerations.

A study that measures the effectiveness of a procedure or treatment should also have external validity, as most studies focus only on internal validity.

In terms of study results, they should be generalizable to similar populations.

In addition, it should be replicable in different situations and with different subjects.

To determine the likely cause of a disease or infection, laboratory and medical records, epidemiology studies, literature reviews, and expert opinions should be consulted.

Hypotheses are tested based on laboratory and environmental findings.

Infections are typically matched with two to four controls based on factors such as age and sex.

The controls are not infected, however, at the time of the study.

Alternatively, researchers can select controls based on their lack of exposure when conducting cohort studies.

In the event that a hypothesis cannot be supported, a new hypothesis may be proposed or different methods of testing may be used.

Our next topic is critical reading.

In order to evaluate research using this method, the following steps must be taken:

The source must be considered
The credentials of the author must be considered
The central claim of the research must be stated in a clear manner
The article’s organization should be examined
The evidence should be reviewed
The overall detail should be evaluated

As for the studies used in statistical analysis, they include the following:

Case-control studies
Cross-sectional studies
Cohort studies
Randomized controlled trial

With research, two types of bias can occur.

First, selection bias.

Subjects chosen for this study do not represent the target population.

This usually occurs as a result of a design error.

Selection bias is only a concern if subjects are deliberately selected for the study.

For example, surveillance studies do not select subjects.

Second, informational bias.

A classification error has occurred here and results in an incorrect estimate of association.

Nondifferential misclassification occurs when both diseased and uninfected people are misclassified similarly.

Lastly, we examine qualitative and quantitative data.

To describe qualitative data, graphs are used, as well as verbal descriptions based on observations.

Data can be gathered through interviews, and the interpretation of this data is crucial.

As these data are often collected in a time-sensitive manner, they can’t be generalized to a larger population.

Usually, this type of information gathering occurs at the beginning of the data collection design phase.

Data that is quantitative tends to be more statistical and usually expressed as numbers.

Depending on the design of the data collection, this is typically done through various tools such as questionnaires, surveys, and other methods that can secure numerical data.

As a result, the research takes on an objective role.

Treatment: Evidence based practice

In order to manage care effectively, we need to discuss evidence-based practices.

Evidence based practice: Classes

In evidence based practice, patients are treated according to the best available evidence, including current research studies.

It is necessary to search the literature for evidence of the most appropriate treatment for specific injuries or diseases.

A clinical pathway outlines specific treatment protocols based on these criteria.

The treatment plan includes not only treatments but also medications and a timeline as well.

This research is usually conducted by specialized organizations that develop guidelines, policies, and procedures that are disease-specific.

Whenever patients meet the disease criteria, these guidelines can be used to treat them.

We must also discuss evidence based nursing.

It aims to improve nursing care quality by identifying the nursing practices that lead to the best outcomes for patients.

To put it another way, nurses make decisions based on evidence.

Guidelines: Evidence based practice

Evidence based practice guidelines are created by combining the following components.

Keeping the topic/methodology in focus
Evidence review
Expert judgment
Policy consideration
Policy
Review

Except for identifying them, we won’t go into great detail; you can expand on it in your coursework.

Critical pathways

Those involved in patient care help develop critical pathways.

Here are the steps to follow:

Based on data and observation, choosing the patient group as well as the diagnosis, procedures, or conditions.
Establishing an interdisciplinary care team that will establish a pathway
Data analysis such as best practice studies and a review of literature can help identify quality improvement opportunities
Nutrition, medication, nursing, and other categories of care are identified
Reaching consensus through discussion
A pathway’s level of care and number of days it covers are identified
Testing and redesign of certain pathway steps if necessary
Staff education regarding standards
In order to improve pathways, variances must be monitored and tracked

A level-based approach to evidence-based practice

According to scientific evidence and legal regulations, levels of evidence can be categorized in a variety of ways.

Category IA: Has strong scientific support from experimental, clinical, and epidemiological studies. There is a strong recommendation for implementation
Category IB: Has a good theoretical basis backed up by some studies. There is a strong recommendation for implementation
Category IC: This is considered as an industry standard or may be a state or federal regulation requirement
Category II: Studies suggestive of epidemiological and clinical evidence support this category. It can be implemented
Category III: Based on descriptive studies, including case studies, comparisons, and correlations. It could prove fruitful if implemented
Category IV: Based solely on expert opinion
Unresolved: Because of a lack of evidence, this category has yet to provide a recommendation

Outcome evaluation

This component is essential for evidence-based practice, which incorporates both internal and external research.

Included in it are:

Continual monitoring during treatment, including documentation of patient progress supported by radiographic and laboratory evidence (when necessary).
Evaluating results. Therefore, acceptable outcomes can be determined
Sustaining means continuing to monitor and evaluate the patient after treatment has been discontinued
Continually improving the treatment to achieve better results
The process of replacing treatments occurs when outcome evaluations show that the current one is ineffective

Risk assessment and quality improvement

Our focus will be on risk assessment and quality improvement in this section.

Quality Improvement and the role of the nurse

There are many ways in which nurses can contribute to quality improvement:

Identify situations
Identify potential items
Data collection
Data analyzation
Change recommendations made
Changes implemented
More data collection to determine if changes work

Management of risk

The risk management team can prevent harm and legal liability by identifying patient risk factors.

Educating patients about these factors and how they can change their behavior can help decrease overall risk too.

To make healthcare decisions, patients must be aware of the risks associated with interventions and treatments.

Taking action to correct any errors is critical, and the physician should be informed as soon as possible.

Hospital policy requires that a mistake be made known to the patient as well.

Afterwards, an evaluation should take place, specifically to determine why things went wrong.

Malpractice, negligence, and torts

Your coursework will clearly explain negligence, malpractices, and intentional and unintentional torts, and you need to be familiar with them.

Delivery of healthcare policies

The goal of a health policy is to improve the quality and efficiency of healthcare systems.

Together, local, state, and federal governments plan, make decisions and take action to accomplish this goal.

These policies can be affected by numerous forces that may affect the delivery of care.

These include:

Social factors
Political factors
Regulatory factors
Economic factors

Concepts regarding billing and reimbursement

We examine Medicare and Medicaid billing and reimbursement in this section.

Medicare

Medicare has existed since 1965 as a federally funded program.

Patients with disabilities and the elderly are eligible, and income is not a factor in eligibility.

In the original Medicare plan, Part A and Part B were included.

The Part C program provides assistance with prescription drugs, while the Part D program combines parts A, B, and C.

Medicare Part A covers:

Inpatient (hospital) care
Hospice care
Home healthcare

For Social Security recipients over 65, automatic enrollment occurs.

Those who have worked 40 quarters or more are also eligible for Social Security benefits because they have contributed to the system.

Medicare Part A requires a monthly payment from anyone who hasn’t worked for 40 quarters.

Medicare Part B covers:

Visits to the doctor and assessments
Physical, occupational, and speech therapy
Medical equipment
Clinical research
Wellness visits
Support for mental health

In order to enroll in Medicare Part B, you must pay a monthly fee.

Medicaid

The first Medicaid program was established for low-income individuals under the supervision of the federal government in 1965.

Approximately 50% to 83% of the plan’s funding comes from the federal government, with the rest coming from state and federal taxes.

Medicaid patients do not have to pay for their treatment, but may have to make small copayments from time to time.

Compensation from third parties

Various third parties offer compensation for medical care.

They include:

Private insurance
TRICARE
Federal Employees Health Benefits Program