N342 Ambulatory Care Test #1 questions with correct answers, Exams of Nursing

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N342 Ambulatory Care Test #1 questions

with correct answers

Key Roles/Responsibilities is Ambulatory Care RN (4) Answer ✓✓1) enhance pt safety and quality/effectiveness of care delivery (irreplaceable)

2. responsible for design/administration/eval of professional nursing services within organization in accordance with nurse practice acts/scope of practice/org standards
3. provide leadership necessary for collab/coordination of services; includes defining appropriate skills mix + delegation of tasks to licensed and unlicensed workers
4. RN fully accountable in amb care for all nursing services and associated pt outcomes provided under their direction Role of RNs in Ambulatory Care (7) Answer ✓✓1) TELEHEALTH NURSE - uses nursing process/tech to care for remote pts.
5. NURSE NAVIGATOR - helps nagivate health system
6. NURSE EDUCATOR - educate pts and educate other nurses
7. NURSE-RUN CLINICS - APRN clinics
8. RESEARCH NURSE - for enrolling pts in trials and providing care during trial

6. CARE COORDINATOR - similar to nurse navigator
7. PROCEDURAL - infusion center, cath lab, amb surgery Categories of Challenges to RNs in Ambulatory Setting (6) Answer ✓✓1) Societal Changes
8. Healthcare environment
9. Integration of Health Records
10. Changing Reimbursement Models
11. Ambulatory Care Nursing Workforce
12. Nursing Education Amb RN Challenges: Societal Changes Answer ✓✓- pop w/ more old people and more diverse w/ complex behavioral needs

• high quality/individalization w/ care tech (mobile devices/social media
• societal violence: challenges of settings lacking infrastructure + resources of larger facility Amb RN Challenges: Healthcare Environment Answer ✓✓-fragmented care delivery; struggle to coordinate across specialties
• amb care increasing regulatory control -- demand for high quality/safety --> impacts reimbursement/ability to compete for contracts

Goal of Affordable Care Act Answer ✓✓LESS HOSPITALIZATIONS AND MORE FOCUS ON PREVENTION Changes from ACA in Slides (5) Answer ✓✓1) gives free preventive care for seniors

2. Community Care Transitions Program for at risk seniors to prevents ED visits and hospital readmissions
3. Increase primary care reimbursement
4. State-sanctioned patient-centered medical homes
5. physician reimbursement changed to value based care models How are nurses meeting ACA goal of quality affordable health care for all Americans? Answer ✓✓increasing use of APRNs and RNs in primary care nurses practicing to the fullest extent How are nurses meeting ACA goal of improving the quality and efficiency of health care? Answer ✓✓improved patient care through nursing education expanded opportunities for nurses to lead/diffuse collaborative improvement efforts achieving high value w/ innovative models

How are nurses meeting the ACA goal of preventing of chronic disease and improving public health? Answer ✓✓Achieving high value w/ innovative models expanding opportunities for nurses to lead/diffuse collaborative improvement efforts How are nurses meeting ACA goal of increasing the healthcare workforce/quality of workers? Answer ✓✓increase in proportion of nurses w/ BSNs ensure nurses engage in lifelong learning How are nurses meeting the ACA goal of strengthening quality, affordable health care for all Americans? Answer ✓✓prepare and enable nurses to lead change to advanced health support students to be change agents Core of what the ACA means for nurses Answer ✓✓nursing in prime time!!

• huge emphasis on APRNs
• RN role in amb care now see as crucial to care coordination
• APRN and RN-led clinics important to increases assess to care and for chronic disease mangement -RNs as clinical leaders Telehealth Competency Categories (7) Answer ✓✓1) Required Knowledge

2. Attitudes

• Is patient
• Can convey empathy through videoconferencing, by facial expression and verbal communication
• Is able to promote privacy and confidentiality in videoconferencing
• Encourages use of electronic measurement devices for collection of detailed patient info
• Promotes importance of a unified way of analyzing and sharing clinical information to improve quality of data and care
• Has confidence that telehealth technology is not difficult to use
• Is open-minded to innovations in ICT (taking into account confidentiality)
• Motivational attitude
• Remains calm, friendly and analytic towards patient when troubleshooting
• Is able to enhance confidence of pt in deployed technology Telehealth Competencies: General Skills Answer ✓✓- Analytical skills - think creatively and problem solve
• Coaching skills
• Prioritization, can switch quickly between patients and different requests for help
• Protects privacy of self and patient Telehealth Competencies: Technological Skills Answer ✓✓- Can train patient to use equipment
• Basic ICT skills - internet and computer
• Check for functionality
• Tech skills in field of new technology
• Electronic health records

Telehealth Competencies: Clinical Skills Answer ✓✓- Combine clinical experience w/ telehealth technology in decision making

• Observation skills - interpret verbal and non-verbal expressions
• Uses health-related data effectively - presents data clearly to colleagues
• Able to measure, compare and interpret data
• Compose risk prevention plan to support patient safe independent living
• Triage and clinical reasoning Telehealth Competencies: Communication Answer ✓✓- Able to listen and ask focused questions, paraphrasing, summarizing
• Able to reveal patient's problem through specific questions
• Empathy
• Communicate clearly and can enhance contact
• Put patients at ease
• Create confidential environment and pleasant atmosphere
• Communicate across different disciplines
• Motivational techniques Telehealth Competencies: Implementation Skills Answer ✓✓- Assess whether telehealth is convenient for patient
• Assess needs and preferences of patient in respect to telehealth
• Communicate effectively benefits of telehealth
• Provide advice about reliable health information on internet - resources Most Important Telehealth Competencies (7) Answer ✓✓1) communication skills

2. coaching skills

What is "connecting with the person" in telehealth? Answer ✓✓literal (having a FACE TO FACT INTERACTION) and figurative terms (developing a relationship/CONNECTION/PLUGGING IN) + BUILDING & MAINTAINING RELATIONSHIPS; being in synch Figurative - interpersonal elements of the therapeutic relationship between nurse and person Literal - meet person in clinical setting or home visit to determine connectivity and computer skills What is "Sharing and reviewing information" in telehealth? Answer ✓✓READING THE PT; PROGRAM PARAMETERS/Qs; COLLAB w/ OTHERS; HAVING FAITH IN INFO review personal data, data from documentation systems, program biometric data, internal and external collaboration with providers Have faith in information from the patient and the technology (how it can affect the accuracy of data collection - correct usage, etc.) What is "recognizing patterns and trends" in telehealth? Answer ✓✓ESTABLISH BASELINE -- COMPARE/CONTRAST RESPOND TO ALERTS + DO A RECHECK identify changes in health, data and behaviors

Use this to determine clinical interventions What is "recording and reflecting" in telehealth? Answer ✓✓CONTEXTUALIZING PT; DOCUMENTING INTERACTION/ACTIVITY broader picture of health and wellness What is "transitioning out" in telehealth? Answer ✓✓Navigating technology, Transferring care, Discharging from program Applying Principles of Assessment/Eval/Dx in telehealth or remote monitoring Answer ✓✓● Ask enough/appropriate questions + Acknowledge patient's concerns ● Patient education ● Use the information you have from their records if applicable ● Err on the side of caution (better be safe than sorry for missing something serious) ● Using layman's terminology ● Ensure patient understands instructions Identify opportunities for improvement during telehealth calls. Answer ✓✓- Not asking enough questions

• Dismissing patient concerns/ideas about what is going on
• Not offering solutions
• No patient education
• Failing to recognize urgent sxs
• Using advanced medical terminology

Utilizes professional interpreters and language lines Accessible to patients in both rural and urban areas Limitation: nurse realized not knowing a person's ethnicity & culture had implications for dietary/lifestyle counselling. nurse said would have changed approach to assessment and health edu. focus -- it illuminates a significant limitation of Getting a Picture purely through mental imagery. How does care coordination affect health care costs? + Examples Answer ✓✓BAD OUTCOMES AND HIGHER COST OF CARE/USE OF RESOURCES!!!! More ER visits polypharmacy minimal preventative care missed immunizations low screenings Serious illnesses disability death More staff used more supplies wasted lower reimbursement for care

Apply the use of care coordination to the clinical setting to improve safety and pt care. Answer ✓✓Typical needs may include transportation to appointments, a refrigerator to store meds, phone to communicate w/ care providers, nourishing food, and a home. Specialty care for diabetes, cancer, or asthma, methadone treatment, mental health treatment, and issues with food security and housing stability are not in and of themselves complex challenges; Complexity arises when the takses and linking of each intervention to the overall care plan fall into the lap of the individual alone w/o effective partnering or support GOAL: change behaviors and choices that are under control of patient --> we as service professionals must get to know each individual, establish a personal, trusting relationship, and connect to motivators that are important to person. Dimensions of CCMT Model (9) Answer ✓✓1) Support for Self-Management

2. Advocacy
3. Education and Engagement of Patient and Family
4. Cross-Setting Communication and Transmission
5. Coaching and Counseling of Patients and Families
6. Nursing Process
7. Population Health Management
8. Teamwork and Collaboration
9. Patient-Centered Care Planning

ASK ME 3 Answer ✓✓What is the main problem? What do I need to do? Why is important for me to do this? Patient-Centered Care Planning Answer ✓✓Pre-Visit Chart Review & Planning, Risk Stratification, & Patient Engagement Motivational Interviewing

• Collaborative/evocative/ supporting pt autonomy
• 4 Guiding Principles: RULE
• Build Rapport
• PAY ATTENTION to CLUES Plan of Care
• development/formalizing of goals & plan of care designed to assist pt in resolving or controlling the dx
• Assessment
• Multidisc. Approach & EBP Care Resources Quality Measures and Outcomes - Analytics Communicating the Plan of Care Monitoring and Measuring Progress

OARS Components and Examples Answer ✓✓OPEN (Ended) QUESTIONS

• a question that invites a person to think a bit before responding AFFIRMING
• to recognize and acknowledge that which is good; to support and encourage REFLECTIVE LISTENING
• designed to clarify your understanding and convey this understanding SUMMARIZING: reflections that pull together several things that a person has told you Elements of Transitional Care Model (8) Answer ✓✓CENTER: Patient and Caregiver

1. Screening
2. Engaging Elder and Caregiver
3. Managing sx
4. Educating/Promoting self-managemnt
5. Collaborating
6. Assuring continuity
7. Coordinating care
8. Maintaining relationships

2. Implementation of evidence-based plan of transitional care
3. Care initiation in a hospital and extends beyond discharge
4. Information sharing
5. Patient engagement
6. Coordinated services Effective Care Coordination Interventions (7) Answer ✓✓1) Follow evidence- based guidelines to manage care
7. Collaboratively develop and implement a plan of care containing specific action plans and goals
8. Implement self-care coaching and support
9. Facilitate communication among the patient's & providers concerns regarding their health status
10. Monitor & evaluate a patient's symptoms, well-being, and adherence to the plan of care
11. Manage care setting transitions 7)Arrange and coordinate needed health-related and community based support services.

Essential Elements of Care Coordination/Nurse Fx Answer ✓✓Care provider responsible for identifying an individual's health goals and coordinating services + providers to meet these goals Expertise in self-management and patient advocacy + will be adept at navigating complex systems and communication w/ a range of people from family members to doctors nurse should be care coordinator when there is medical frailty or complexity! Emory Examples of Care Coordination (6) Answer ✓✓EHN RN Care Coordinator

• Vulnerable Complex High Risk patients attributed to the Emory Healthcare Network RN Advisor
• Telephonic communication with patients whom have an identified healthcare need Winship Nurse Navigator
• Oncology patients receive cancer treatments and educate their patients about their diagnosis Transplant Coordinator
• Transplant patients navigate transplant centers and monitor disease/medication therapies Triage RN