Exam (elaborations)

Advanced Practice Nursing

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Advanced practice nursing

Institution
Advanced Practice Nursing

Bundle Payments and health care expenditures - answer-- Also known as bundle payments - Reimburstment of health care providers on the basis of expected cost for clinically defined episodes of care - "middle" ground between fee-for-service and capitation - healthcare delivery system takes on fina...

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Uploaded on October 29, 2024
Number of pages 12
Written in 2024/2025
Type Exam (elaborations)
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advanced practice nursing

Institution Advanced practice nursing
Course Advanced practice nursing

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Advanced Practice Nursing
Bundle Payments and health care expenditures - answer-- Also known as bundle
payments
- Reimburstment of health care providers on the basis of expected cost for clinically
defined episodes of care
- "middle" ground between fee-for-service and capitation
- healthcare delivery system takes on financial risk of patient
- Forces system to enhance quality and coordination of care
- Incentivizes system to deliver care that truly meets the Triple Aim

CHIP - answer-- Children's Health Insurance Program
- Health coverage to uninsured children whose families earn too much to qualify for
Mediciad but too little to afford private coverage

Role Strain - answer-Subjective feelings of frustration, tension, or anxiety
expierenced in response to role stress & can be feelings of decreased self-esteem
when performance is below expectations

Role Conflict - answer-Role expectations are percieved to be mutually exclusive or
contraditctory

Medicare Part D Billing - answer-- Prescription drug coverage
- Must join a drug place to receive coverage under part D
- Coverage is attempt to lower prescription costs
- Payment is monthly fee that varies by plan & is addition to Part B premium or
inbedded in Part C premium

Role Stress - answer-A situation of increased role performance demand (ex:
returning to school while maintaining work and family responsibilities or the
expectation of increased workload

Medicare Part B Billing - answer-- Covers medical expenses such as physician and
outpatient care
- Direct reimbursement can only occur when submitting claim through part B
- Covers physician and nonphysical provider services, outpatient hospital services,
home health care not covered by part A (PT/OT) and other services such as
diagnostic testing, durable medical equipment and ambulance costs
- Enrollment in part B is voluntary to those receiving Part A
- Payment into system via monthly premiums that are established yearly based on
system expenses through deductibles & coinsurance programs

Advanced Practice Nurse Roles - answer-1. Nurse Practitioner
2. Clinical Nurse Specialist
3. Certified Registered Nurse Anesthetist
4. Certified Nurse Midwife

Nurse Practition - answer-- provide care through diagnosis and treatment as well as
addressing disease prevention and health management

, - 1893 Lillian Wald & Henry Street Settlement (HSS) House
- HHS nurses obtained standing orders for emergency medications and treatments
- nurses considered "good enough" to care for the poor whereas physicians seen as
only careing for those who could pay
- FNS/FSA nurse practice centered around the practice autonomy in the requirement
that the patients be poor, marginalized and have little access to physician provided
medical care
- NP role formally described in 1960s and was implemented in outpatient pediatric
clinics in response to a shortage of primary care physicians
- Loretta Ford in 1965 established first Pediatric NP program (PNP) & was designed
to prepare professional nurses to provide comprehensive well-child care and
manage common childhood health problems
- 1970 continue to enhance visibility in health system, and expand role while
demonstrating cost effective quality care
- role expanded/included because nurse role was essential to providing equal access
to health care for all Americans
- conflict surrounds role between other RN and NP and NP and physicians
- issues surrounding prescriptive treatment & idaho in 1971 was first state to
recognize diagnosis and treatment as part of practice
- Support DNP but does not require educational programs to be at the doctoral level

Clinical Nurse Specialist - answer-- evolved out of increasingly complexity of nursing
care
- roots in psychiatric nursing
- psych specialists date back to 1880 & richards is credited with founding specialty
of psych nursing specialists
- Rutgers University first educational program for CNS but was for psychiatric
nursing
- coronary care nurse specialists established in 1962 & CCU nurses blurred invisible
boundary separating nursing and medicine
- 1960s noted to be when clincal nurse specialist took on modern day form
- three social forces drove specialization 1. increase in specialty related information
2. new tech advances 3. response to public need and interests
- crtical care and oncology specialty grew in 1970s
- ANA recognized CNS role 1970s defining the CNS as an expert practitioner and
change agent
- master degree required
- role has postive effect on improving nursing care and patient outcomes
- view shift from direct patient care to education and organizations (seen as too
valuable)
- education complex due to number of specialties involved
- can prescribe without physician supervision in 20 states now
- 1997 Balanced Budget Act identified CNS eligible for Medicare reimburstment

Certified Registered Nurse Anesthetist - answer-- history in civil war
- typically anesthesia given only when a physician was unavailable
- Dr Mayo first to recognize and formally train CRNA in 1889
-Alice Macaw mother of anesthesia (hired by mayo)
- early challenges but practice has grown
- 1931 Lakeside hospital establishes National Association of Nurse Anesthetists

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