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The care coordinator is planning actions to overcome a client's knowledge deficit related to the use of a sleep apnea machine at home. Which approach should the nurse use for this situation?
Review the steps in using the machine again
-To overcome the barrier of deficient knowledge, the nurse should provide additional teaching to ensure client comprehension of the instructions. Scheduling would address the barrier of limited resources. Discussing the issue with the interdisciplinary team is an action to address limited resources. Explaining the consequences of not using the equipment correctly is not a strategy to overcome any care coordination barriers.
The nurse is coordinating the care for a client recovering from a stroke. Which skills are appropriate for the nurse to use when coordinating care for this client?
Communicate with other disciplines regarding the provision of care
Facilitate team and group activities to avoid scheduling conflicts
-When functioning in the role of coordinator, the nurse will facilitate team and group activities and use verbal communication skills with other disciplines to ensure completion of the client's care. Delegation is a skill used in team nursing. Documentation is a basic nursing skill performed by all nurses regardless of the care delivery method used. Discussing the client's need for a medication with the insurance provider is a skill within the role of advocacy.
The nurse administers a dose of the pneumococcal vaccination to an older client prior to the client's discharge from the hospital. Which function of managed care is this nurse performing?
Delivering preventive services
Managed care emphasizes preventing inappropriate and unnecessary costs, increasing customer satisfaction, promoting health, and delivering preventive services. Administering a vaccination is the delivery of a preventive service. Assessing client needs is a step within the nursing process and case management. Providing a vaccination is delivering a preventive service and not preventing unnecessary costs. The nurse who is administering a vaccination is not engaged in advocacy.
The nurse case manager is assigned a client newly diagnosed with type 2 diabetes mellitus. What is the priority action for the nurse to perform when beginning the care of this client?
Complete a health history
Case management is a care delivery approach used to coordinate, facilitate, and track a client's use of healthcare resources. This care delivery approach begins with assessing client needs. Implementing care (e.g., providing teaching on insulin administration) occurs after the assessment and plan is prepared. Discharge planning and collaboration with other healthcare professionals occur after the assessment.
The staff development educator is preparing a seminar for staff nurses prior to implementing managed care. Which skills should the educator include as necessary when implementing this care delivery system?
time management, communication, assessment, delegation
med admin is direct client care, not managed care
The nurse manager is concerned that client care coordination was not successful. On which observations did the nurse manager base this concern?
The client's abdominal wound dressing was changed twice in one shift.
Referral for home care has been delayed by two days.
The client's fasting blood glucose level was drawn twice in one day.
The client received two doses of a prescribed pain medication.
The nurse manager is reviewing current staff education levels and skill competencies for charge nurses to use when making client assignments. Which care delivery system does this nurse manager's action support?
During a follow-up visit, the nurse learns that a client is not adhering to the agreed upon plan of care. What outcome should the nurse expect for this client's care?
Exacerbation of the health problem
If the client is not adhering to the plan, the client is at risk for re-hospitalization or exacerbation of the health alteration. Limited access to resources may hinder client progress in the form of missing scheduled appointments or not understanding the plan of care. A client with deficient knowledge may not comprehend information provided during a teaching session.
care that is NOT coordinated
can lead to fragmented services, medical errors, and unnecessary duplication of tests, services, and treatments, as well as to omission of necessary services
Organizes health care around client physical and emotional needs
Incorporates concepts of client and family-centered care
Ensures clients and families participate in decision-making and care delivery process
Analyzes nurses' education, training, and ability to determine how to best utilizes nurses in the care setting
Provides specific roles and job descriptions for nurses according to education, training, and ability
Based upon competencies needed to provide client care
Delineates roles between licensed and unlicensed assistive personnel (UAP)
Organizational model that ensures nurses have input on policy and decision making related to client care
Goal is to improve staff commitment to the organization through participation in planning and decision-making
Nursing and leadership staff collaborate when making, implementing, and evaluating client care policies
Encourages decision-making at all levels of the organization
Nurses participate through work groups or task forces
Decisions may address employment conditions, cost-effectiveness, long-range planning, productivity, wages, and benefits
Which strategies are emphasized in managed care?
focuses on decreasing costs and improving client outcomes. It emphasizes preventing inappropriate and unnecessary costs, increasing customer satisfaction, promoting health, and delivering preventive services.
Which client health problem would benefit the most from case management?
CHRONIC lung disease
What are characteristics of shared governance?
Encourages decision-making at all organization levels
Can be used with other care delivery methods
case method of care
precursor to primary nursing
uses a task-oriented approach
one nurse is assigned and responsible for the care of a group of clients over the course of a shift
RN has the responsibility and authority for client care but delegates tasks to other team members as appropriate
one nurse is responsible for overseeing the total care for a number of clients 24 hours a day, 7 days a week
What organizations have embraced the use of care coordination?
What is a defining characteristic of care coordination?
initiation by the nurse
Which action is characteristic of the "planning care" phase of the care coordination process?
Utilize standard protocols or critical pathways and evidence-based guidelines
determine need for consult?
ID possible challenges
problem identification phase
adjusting the plan
Which is a barrier to care coordination?
Limited access to resources such as a lack of transportation
Which strategy is useful to overcome barriers related to care coordination?
One way to overcome a barrier to care coordination is to address knowledge deficits by providing additional teaching to ensure that the client comprehends discharge instructions
Abigail, the registered nurse, is meeting with the physical and occupational therapists to discuss outcome achievement for a client recovering from a stroke. Which case management behavior is the nurse demonstrating at this time?
eval care provided
Jennifer Calper, the primary nurse, is assigned a client with newly diagnosed type 2 diabetes mellitus. Which nursing action is most appropriate when caring for this client?
Instructing the client on the role of medications to control the disease process
Katrina Simons is a nurse who is coordinating the discharge for a client with chronic lung disease. Which nursing action is the priority when coordinating this client's care?
Obtaining an order and organizing the delivery of oxygen to the client's home
While coordinating the care for Mr. Obertone, an adult client with heart failure, the nurse discovers that home monitoring equipment is not available for several days. Which nursing action is most appropriate to overcome this care coordination barrier?
Contact another company to obtain the needed resource
The nurse manager is evaluating care coordination actions performed by the nursing staff. Which outcomes indicate that the nursing staff's actions have been effective?
reliable, accessible, of the highest quality, and at the lowest cost
The neurological clinical nurse specialist (CNS) visits a client at home one week after the client was discharged from the hospital after a stroke. What can the CNS do after this care visit is complete?
Reimburse for the care visit
(visiting within 30 days of discharge)
Which client should the nurse refer to the case manager for ongoing care?
Client with exacerbation of multiple sclerosis
chronic vs. acute
The nurse telephones a health insurance carrier to discuss covering an electric wheelchair for a client with a spinal cord injury. Which barrier of care coordination is the nurse attempting to overcome?
While caring for a client, the nurse meets with the healthcare provider to discuss responses to treatment and explain the client's issues with medication side effects. Which associated concepts of managed care is this nurse demonstrating?
The registered nurse team leader is performing gastric lavage for a client who is experiencing an acute gastrointestinal bleed. Which function will the nurse most likely have difficulty completing as the team leader?
Team nursing is not as effective when caring for clients who are acutely ill because the nurse is needed for direct care and will not have time to delegate many tasks. Teaching, identifying nursing diagnoses, and decision-making are skills used within primary nursing and would be required when caring for this client.
A medical-surgical unit utilizes the case method for providing client care. Which actions will the nurse perform when caring for clients using this approach?
Providing total care to assigned clients for the entire shift
The primary nurse is coordinating care for a newly admitted client. Which nursing actions are appropriate when planning this client's care?
Identify applicable evidence-based practice guidelines for the client's care
Select appropriate critical pathways for the client
delegate to uap
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