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Nur 425 Exam 1 Study Guide with Questions and Answers
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  • NUR 425
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  • NUR 425

Medicare the most expensive healthcare. Recipients are reimbursed by predetermined amount such as a fix cost per case. Hospitals are paid by the quality of service that is provided Medicaid a joint federal and state program that helps with costs for people with limited income and resources Diagno...

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  • September 9, 2024
  • 18
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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  • nur 425 exam 1 study guide with questions and answ
  • medicare the most expensive healthcare recipient
  • medicaid a joint federal and state program that h

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Nur 425 Exam 1 Study Guide with
Questions and Answers
Medicare ✅the most expensive healthcare. Recipients are reimbursed by
predetermined amount such as a fix cost per case. Hospitals are paid by the quality of
service that is provided

Medicaid ✅a joint federal and state program that helps with costs for people with
limited income and resources

Diagnosis related groups ✅they are a prospective payment system for hospitals and
other healthcare providers

Cultural diversity within nursing ✅currently there are over 2.1 million nurses in the
us....
-<4.9% are black
-3.7% asians
-2.0% hispanic
-0.5% na/alaskan
-5.4% men

Benchmarking ✅a comparison of what your hospital is doing against another hospital
or specific standards or care
-strategy used by organizations to compare performance outcomes
-we need it to improve care
-one manager may want to compare their time it takes for a patient to be admitted and
seen by a physician to the time for the same process at another hospital.

Quality management ✅really about reducing errors and preventing legal issues
-preventative approach designed to address problems before they become a crisis
-program to prevent problems in the hospital
-without quality and risk management programs healthcare organizations would never
know how many errors occur, how to prevent errors and reduce litigation (law suits).

Risk management ✅program designed to reduce the organizations risks and lawsuits
-must involve everyone in the organization; identifies the risk
-establishes programs to prevent and reduce risk
-educates, monitors, evaluates

Quality programs ✅focus on the improvement of organizational process to prevent
potential problems
-total quality management
-continuous quality improvement

,-benchmarking
-six sigma

Quality improvement ✅older method to find erros and is viewed by nurses
-the qi nurse seeks to find the nurse responsible for making the errors, and this usually
resulted in a disciplinary action.
-there is a peer on a qi team who makes a specific audit tool to find mistakes made by
the staff → the report is given to the manager
-nurses do not like the qi system for that reason.

Where did total quality management come from? ✅edward dwinning
-came up with looking at japan;s car industry which then has flowed out everywhere and
health care adopted it

Total quality management ✅-everyone in the organization must be part of this process
and has a role in it for positive results
-goal is for the organization to be efficient as possible and provide quality care in safe
and timely manner
-units focus on what their needs are using the method rood cause analysis
*customer/client focused, uses numbers to measure success (quantitative) such as
press gainey scores and seeks ways to improve process within the organization.

Total quality management example ✅in mother baby, babies falling off of beds due to
mom/dad falling asleep or needing to encourage breastfeeding. Critical care problems:
respiratory infections

Total quality management characteristics ✅-customer focus
-total organizational support
-tools for measurement
-identification of key processes for change

Total quality insurance ✅a team of nurses come into audit the charts for example
using weights
-they will make a report and then call the nurse manager to call out other nurses who
are making the mistakes to stop them

Continuous quality improvement ✅process implemented to improve the organizations
quality and performance
-review of systems to improve patient care, it never ends, the cqi team members
evaluate, act and try to improve process or how things get done.
-4 members in the process

Members in continuous quality improvement ✅-resource group: senior management
-coordinator: provides day-day management of the cqi process
-team member: evaluate and improve the processes

, -team leader: organizes the meetings and guides process, and evaluation

Six sigma ✅program used to analyze quality improvement based off numbers. -
numbers (quantitative) measure specific goals of the organization

Elements of six sigma ✅patient focused, uses specific data, reviews processes,
proactive (preventing something from happening), collaborative involvement, seeks
perfection

Plan do check and act program ✅-plan: to improve by finding out what is wrong
(identify the problems), and develop ideas for solving these problems.
-do: changes to solve the problems on a small scale first to test whether the changes
will work or not.
-check: whether the small scale or experimental changes are achieving the desired
result. Continuously check key activities to ensure that the quality of the output is at all
times to identify any new problems that might come up.
-act: to implement changes on a larger scale if the plan is successful or make the
changes a routine part of your activity. Act to involve other people (other departments,
suppliers, or customers) affected by the changes and whose cooperation you need to
implement on a larger scale.

Recruitment and retention issues with men children and minorities ✅-there are not
enough nurses which leads to lower nurse-patient ratios
-we need more nursing faculty for each clinical groups, more sites for clinicals, job
shadows with interviews, etc. To help improve the nursing shortage overall
-bona fide occupational qualification (bfoq)

Bona fide occupational qualification ✅-create exemptions to the acts against
discrimination/disability
-questions that the validity of the procedure used to make the personal decision and
allows discrimination on the basis of national origin, religion , sex and age if that
discrimination can be shown to mess up the normal operation of a business

Rising cost of healthcare factors ✅medication errors are increasing healthcare cost
-aging patient, people are living longer, leads to an increased healthcare needs =
having difficulty paying for medications and have a loss of insurance coverage

Shared governance ✅nursing staff are formally organized at the service area and
organizational levels to make key decisions about clinical proactive standards, quality
assurance and improvement, staff development, professional development, aspects of
unit operations and research
-allows decision making at all levels, accountability
-based on the philosophy that group is best determined by its members
-members have control over decisions of practice

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