Nursing Chapter 9 Homework Medicare There Were Two Purposes 1 Utilization

Chapter 9: Special Responsibilities of the Manager

Learning Outcome 1

Define key terms associated with standards.

Concepts for Lecture

1. Standards are agreed-upon levels of excellence, or established norms of expected

2. Criteria are necessary in addition to a set of standards; criteria are predetermined

3. Accreditation is received by meeting a comprehensive set of standards made by the Joint

4. Structure standards usually address the integrative mechanisms of an organization, such

as the environment, instrumentation, qualifications of personnel, job categorizations,

5. Process standards address nursing activities that nurses perform, and are written

statements including nursing actions of assessment, diagnosis, interventions, and

6. Outcome standards address the end results of client care, and so are patient-centered and

usually identified along with the process standards. The standards of patient/client care

PowerPoint Slides

1. Standards

• Established norms of expected conduct.

• Provide guidelines for care provided and professional responsibilities.

• Standards of nursing are usually classified in one of three ways

o Structure standards

2. Criteria and indicators

• Criteria

o Predetermined elements, qualities, or characteristics

o Used to measure the extent to which a standard is met

• Indicators

3. Accreditation

4. Structure standards

• Address the integrative mechanisms of an organization, such as:

o The environment;

o Instrumentation;

o Qualifications of personnel;

o Job categorizations;

5. Process standards

• Address nursing activities that nurses perform.

• Written statements that include:

o Nursing actions of assessment;

o Diagnosis;

6. Outcome standards

• Address the end results of client care.

• Patient-centered

• Usually identified with process standards

Figure 9-1: The variety of forces that create the climate for establishing standards of

practice that ensure quality patient care

Suggestions for Classroom Activities

• Split the class up into small groups of two or three, and assign each group a Web site

from the reference list below. As a homework or in-class assignment, have each group

Reference

• American Association of Colleges of Nursing: http://www.aacn.nche.edu.

Learning Outcome 2

Describe three stipulations required to meet certification standards.

Concepts for Lecture

1. Certification is an example of a structure standard, and reflects certain qualifications of

an individual rather than of an agency; it is a credential that enhances one’s professional

2. In 1973, the American Nursing Association (ANA) created the ANA certification

program to provide tangible recognition of professional achievement in a defined

functional or clinical area of nursing. In 1991, the American Nurses Credentialing Center

PowerPoint Slides

1. Certification

• An example of a structure standard

• Reflects certain qualifications of an individual rather than of an agency.

2. History of certification

• 1973: ANA created the certification program:

o Recognition of professional achievement in a specific area of nursing

o Provides certification exams in 37 specialized and advanced practice

Suggestions for Classroom Activities

• As a homework assignment, have students go to the American Nurses Credentialing

Center Web site. Have students see whether there is a certification for the practice area

where they want to work. If so, what credentials do they need to become certified?

Reference

Learning Outcome 3

Concepts for Lecture

1. The Medicare program began in 1965 as an amendment to the Social Security Act of

1935, and is the largest single payer in the United States. Congress enacted three pieces

2. The Bennett Amendment established professional standards review organizations,

providing for a review of medical care at those institutions receiving federal

reimbursement, such as Medicare. There were two purposes:

3. The purpose of the National Health Planning and Resource Development Act of 1974,

4. The Social Security Act Amendments, Prospective Payment for Medicare Inpatient

Hospital Services had the most significant impact of governmental regulation because it

changed the way hospitals were reimbursed for Medicare clients. Essentially, it involved

PowerPoint Slides

1. Medicare

• Began in 1965 as an amendment to the Social Security Act of 1935.

• Largest single payer in the U.S.

2. The Bennett Amendment (1972)

• Established professional standards review organizations.

• Provided a review of medical care at institutions receiving federal reimbursement.

• Two purposes

3. The National Health Planning and Resources Development Act (1974)

• Amended in 1979

4. The Social Security Act Amendments (1983)

• Most significant impact of governmental regulation

• Changed the way hospitals were reimbursed for Medicare clients.

Suggestions for Classroom Activities

• Question students about their awareness of the requirements and standards of the

regulatory bodies in their day-to-day practice, as well as their perceptions of them. Ask

Reference

• 92nd Congress of the United States (1972). Social Security Amendments of 1972

Learning Outcome 4

Discuss the relationship between clinical practice guidelines and outcome standards.

Concepts for Lecture

1. Clinical practice guidelines are intended to assist practitioners in the prevention,

diagnosis, treatment, and management of clinical conditions, thus presenting the best

2. As noted before, outcome standards address the end results of client care, and so are

patient-centered, and are usually identified with the process standards, such as the clinical

PowerPoint Slides

1. Clinical practice guidelines

• Assist practitioners in the prevention, diagnosis, treatment, and management of

clinical conditions.

• Provide the best patterns of practice for a particular condition.

• Used for:

2. Relationship between clinical practice guidelines and outcome standards

• As noted before, outcome standards address the end results of client care.

Figure 9-2: A graphic of a quality assurance model

Suggestions for Classroom Activities

• As a homework assignment, have students create a Venn diagram to compare and

contrast clinical practice guidelines and outcome standards. Pose questions beforehand

such as: How are they interrelated? How are they different? Encourage students to share

their diagrams with the class.

Reference

• American Association of Clinical Endocrinologists guidelines: http://www.aace.com.

Learning Outcome 5

List the conditions that must be met to claim injury due to negligence.

Concepts for Lecture

1. Negligence is the carelessness or failure to act as a prudent person would ordinarily act

2. For the plaintiff, the individual claiming injury, to bring about a lawsuit, the following

conditions must be met:

a. Proof that the nurse owed a duty to the patient;

PowerPoint Slides

1. Negligence

• Carelessness or failure to act as a prudent person would ordinarily act under the

2. Conditions that must be met to claim injury due to negligence

• Proof that the nurse owed a duty to the patient

Case Study: An Incident Report

Suggestions for Classroom Activities

• Create various situations that could commonly occur in the health care setting: one for

each proof of negligence and three or four more that are not negligent. Then split the

GENERAL CHAPTER CONSIDERATIONS

1. Have students study and learn key terms listed at the beginning of the chapter.

2. Have students complete end-of-chapter exercises either in their book or on the MyNursingKit

Web site.

MYNURSINGKIT

(www.mynursingkit.com)