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2400 Final Exam Study Guide
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2400 Final Exam Study GuideTeam Nursing - ANS-A care delivery model that assigns staff to team that then are
responsible for a group of patients
Primary Nursing - ANS-A care delivery model that clearly delineates the responsibility
and accountability of the RN and deignates the RN as the primary provider of care to
patients
Functional Nursing - ANS-Divides nursing work into functional roles that are then
assigned to one of the team members. Each care provider has specific duties or tasks
for which they are responsible
Total Patient Care - ANS-The nurse is responsible for the total care for assigned
patients for the shift worked. The RN has several patients for whom she is responsible.
The LPN and NAP may help but they are not assigned to a specific group of patients.
Managed Care - ANS-A structure that allows health
insurance organizations contract with health
care providers and medical facilities to provide
care for members at reduced costs.
These providers make up the plan's network.
How much of the patient cost of care will be
reimbursed depends on the network's rules.
Restrictive plans generally cost less. More
flexible plans cost more.
The health care is managed by the federal,
state, local, and private organization
PPO - ANS-*Preferred Provider Organization*
usually pay more if the patients
get care within the network, but they
still pay a portion if they go outside
HMO - ANS-*Health Maintenance Organization*
usually only pay for care within
the network. Patient chooses a
primary care doctor who coordinates
most of your care.
, POS - ANS-*Point of Service* Plan
lets patients choose between an HMO or
a PPO each time they need care
DRG - ANS-*Diagnosis-Related Groups*
Used as groupings of patients to which a nursing acuity is assigned based on past
organizational experience.
---Are patient groupings established by federal government for reimbursement purposes
---Sorted by patient disease or condition
Purpose of Managed Care - ANS-Managed care is a structure that allows health
insurance organizations contract with health care providers and medical facilities to
provide care for members at reduced costs. These providers make up the plan's
network. How much of the patient cost of care will be reimbursed depends on the
network's rules.Restrictive plans generally cost less. More flexible plans cost more. The
health care is managed by the federal, state, local, and private organization
Principles of Managed Care - ANS-•*Focus on outcomes* - both costs & quality are
analyzed. Less costly treatments may not save money. Care Paths
•*Quality of care* - most agencies now demand quality improvement activities & want
results for evidenced-based care.
•*Accreditation* - some facilities are questioning whether JCAH is best agency for
accreditation
RN's Role in Managed Care - ANS-•*ADN vs. BSN* -currently agencies do not
discriminate between ADN & BSN grad's but BSN prepared nurse is appointed to a
managerial role faster than an AND.
•*Floating* - is expected of todays RN's, who must be aware of their strengths and
limitations.
Profit vs Non-Profit - ANS-For profit and non profit organization exist within the private
sectors and the government. They provide access to cost effective and quality health
care. A wide range of services (regulated) are provided at a controlled cost
Role of the Nurse Case Manager - ANS-•Focuses on patient while patient is
hospitalized or while at rehabilitation
•May specialize in types of diagnoses/conditions
•Ensures that patient receives appropriate care and is discharged appropriately so as to
prevent future frequent hospital admissions.
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