Nursing Scope of Practice Chapter 1

Podcast Beta

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What attribute of caring is defined as being deeply attuned through intentional and authentic presence?

Courage

Authentic presence

Advocacy

Knowing (correct)

Which statement best describes the relationship between nursing and caring?

Caring does not influence patient outcomes in nursing.

Caring characterizes nursing's knowledge base and services. (correct)

Caring is secondary to the medical diagnosis.

Caring is only significant in emergency nursing.

How is advocacy defined within the context of nursing?

Encouraging patients to rely entirely on clinical assessments.

GADOW-Existential advocacy, partnering fully in the situation. (correct)

Supporting patient care exclusively through medical treatments.

Following strict hospital policies without considering patient feelings.

What does 'authentic presence' in nursing primarily involve?

Intentionally being with another in one's fullness of personhood. Signup and view all the answers

What is a hallmark of a broadened approach to therapeutics and interventions in nursing?

Viewing human responses as calls for nursing. Signup and view all the answers

What is a primary reason Medicare Advantage plans have become less financially viable?

High medical utilization of beneficiaries Signup and view all the answers

What type of Medicaid eligibility method was established by the ACA?

Modified Adjusted Gross Income (MAGI) Signup and view all the answers

Which of the following is NOT a common type of Medicare Advantage plan?

Exclusive Provider Organization (EPO) Signup and view all the answers

Who jointly funds Medicaid programs?

Federal and state governments Signup and view all the answers

Which group is exempt from meeting the MAGI requirements for Medicaid eligibility?

Citizens over 65 years Signup and view all the answers

What happens if a Medicare Advantage plan's payout exceeds the fixed annual payment from CMS?

The plan incurs a loss Signup and view all the answers

What is a benefit of Medicare Advantage plans for beneficiaries regarding out-of-pocket expenses?

They provide a limit on yearly out-of-pocket expenses Signup and view all the answers

What is a common problem faced by Medicare Advantage plans?

Higher-than-expected healthcare costs for beneficiaries Signup and view all the answers

What is the primary definition of primary care?

Continuous, person-centered, relationship-based care. Signup and view all the answers

Which of the following is NOT one of the core competencies for APRNs?

Pharmaceutical Management Signup and view all the answers

Which element is included in the CIRCLE OF CARING MODEL?

Courage Signup and view all the answers

What is meant by the term 'scope of practice' in nursing?

The legal framework defining what tasks nurses can perform. Signup and view all the answers

Which aspect is essential for the future success of nursing?

Ensuring a diverse nursing workforce. Signup and view all the answers

What is the purpose of Medicare's National Provider Identifier (NPI)?

To facilitate healthcare provider billing processes. Signup and view all the answers

Which domain emphasizes the importance of leadership in nursing practice?

Personal, Professional, and Leadership Development Signup and view all the answers

What is one of the elements included in the diagnostic process?

Location Signup and view all the answers

What percentage of the approved Medicare rate is a patient charged for physician office visits after payment?

20% Signup and view all the answers

Why is it important to collect patient out-of-pocket payments before rendering services?

To avoid direct patient billing later. Signup and view all the answers

What is the initial coverage limit for Medicare D in 2021?

$4,120 Signup and view all the answers

What occurs when a Medicare beneficiary's out-of-pocket expenses reach $6,350?

Catastrophic coverage becomes available. Signup and view all the answers

What is one main advantage of Medicare Advantage plans?

They may cover additional services like dental care. Signup and view all the answers

What is the purpose of the donut hole in Medicare D drug coverage?

To promote awareness of drug costs and choices. Signup and view all the answers

Medicare Advantage plans must offer which of the following?

All Medicare required services. Signup and view all the answers

How does the requirement for providers to collect copayments and deductibles affect their operations?

It increases the cost and time for patient collections. Signup and view all the answers

What does Title I of HIPAA primarily address?

Insurance coverage for workers and families who change jobs Signup and view all the answers

Which of the following is NOT considered a primary prevention method?

Cancer screenings Signup and view all the answers

Which component is essential in managing patient health/illness status according to revised NONPF competencies?

Patient education and coaching Signup and view all the answers

Which of the following best describes tertiary prevention?

Treatment to prevent further complications of diseases Signup and view all the answers

What is the main focus of the nurse coaching approach?

Promoting integrative health and behavioral change Signup and view all the answers

What was a key contribution of Virginia Henderson to nursing?

Foundational concepts of community health nursing Signup and view all the answers

In Ryan's Integrated Theory of Health Behavior Change, what role do Advanced Practice Nurses (APNs) play?

They facilitate and support health behavior changes. Signup and view all the answers

What is a major aspect of symptom management as described in the content?

Reviewing symptoms as subjective experiences Signup and view all the answers

Which factor contributed to the reevaluation of traditional medical roles?

Increased specialization and narrow focus on diseases Signup and view all the answers

What does the Circle of Caring emphasize in nursing practice?

Holistic approaches considering individual patient experiences Signup and view all the answers

Which nursing model emphasizes the importance of a holistic patient database?

Shuler's NP practice model Signup and view all the answers

Which of the following roles is part of the revised 7 domains for nurse practitioners?

Management and negotiation within healthcare systems Signup and view all the answers

Which aspect does NOT fall under the category of administrative simplification in Title II of HIPAA?

Reorganizing hospital administrative departments Signup and view all the answers

What preventative screening is classified under secondary prevention?

Screening for high blood pressure Signup and view all the answers

Which core competency emphasizes the importance of quality and safety in nursing practice?

Quality and Safety Signup and view all the answers

Which element in the CIRCLE OF CARING MODEL symbolizes the dedication to persistent support for patients?

Commitment Signup and view all the answers

What is required for providers to bill Medicare for their services?

Obtaining a National Provider Identifier (NPI) Signup and view all the answers

What primarily defines primary care in the provided context?

Continuous, person-centered care Signup and view all the answers

Which of the following themes is crucial for the future success of nursing practice?

Diversity in the nursing workforce Signup and view all the answers

When billing Medicare for services, what must providers agree to accept?

CMS-approved amount as full payment Signup and view all the answers

Which of these elements is NOT part of the diagnostic process?

Treatment history Signup and view all the answers

What is one of the primary goals of the Healthy People 2030 initiative?

To improve health outcomes among diverse populations Signup and view all the answers

What is one of the major financial challenges faced by Medicare Advantage plans?

High medical utilization from beneficiaries Signup and view all the answers

Which statement best describes the funding structure for Medicaid?

It is jointly funded by federal and state governments. Signup and view all the answers

Under the Affordable Care Act (ACA), which income assessment method is used for Medicaid eligibility?

Modified Adjusted Gross Income (MAGI) Signup and view all the answers

What can beneficiaries of Medicare Advantage plans do regarding noncovered services?

Use them but incur higher costs Signup and view all the answers

Which common type of Medicare Advantage plan is focused on requiring members to use a network of providers?

Health maintenance organization (HMO) plans Signup and view all the answers

Which group is generally NOT included in the financial eligibility criteria for Medicaid benefits?

Full-time employed adults with high incomes Signup and view all the answers

What might happen if a Medicare Advantage plan's annual payout exceeds the payment received from CMS?

The plan may become financially unstable Signup and view all the answers

What role does the Children’s Health Insurance Program (CHIP) play alongside Medicaid?

Provides coverage to uninsured children in families with incomes too high for Medicaid. Signup and view all the answers

What was the Medicare Part A deductible in 2021?

$1,484 Signup and view all the answers

What percentage of the physician fee is covered by CMS for NP services?

85 Signup and view all the answers

How much does a patient pay for hospital stays from days 61 to 90 under Medicare?

$371 per day Signup and view all the answers

What is the maximum number of lifetime reserve days a Medicare beneficiary can use?

60 Signup and view all the answers

What was the Medicare B deductible for the year 2021?

$203 Signup and view all the answers

What is the copayment for days 21 to 100 in a skilled nursing facility under Medicare?

$185.50 per day Signup and view all the answers

What strategy is reflected in the Medicare Physician Fee Schedule as of 2021?

Enhance accessibility and quality Signup and view all the answers

How much do beneficiaries typically pay out of pocket for their secondary insurance plan?

$50 to $300 per month Signup and view all the answers

What is the primary responsibility of Medicare beneficiaries regarding their out-of-pocket payments before receiving services?

They should verify their payment responsibility and pay before receiving services. Signup and view all the answers

What happens when a Medicare beneficiary's expenses exceed the initial coverage limit for Medicare D in a given year?

They qualify for catastrophic coverage and pay only a reduced copay. Signup and view all the answers

Which of the following is a key feature of Medicare Advantage plans?

They require approval from CMS and often offer enhanced benefits. Signup and view all the answers

Why is the 'donut hole' a significant aspect of Medicare D coverage?

It serves to encourage consumers to be more mindful of drug prices and choices. Signup and view all the answers

What is the required patient payment for physician office visits post initial payment under Medicare?

20% of the approved Medicare rate. Signup and view all the answers

What does ACA legislation aim to do regarding the donut hole in Medicare D?

Fully eliminate the donut hole by 2025. Signup and view all the answers

Which statement regarding patient billing practices is accurate?

Collecting payments before services reduces processing costs long-term. Signup and view all the answers

What defines catastrophic coverage in Medicare D for the year 2021?

Coverage becomes active once out-of-pocket costs reach $6,350. Signup and view all the answers

What is the primary objective of Title II of HIPAA?

To establish national standards for electronic health-care transactions Signup and view all the answers

Which of the following is an example of tertiary prevention?

Management of cardiovascular disease to prevent complications Signup and view all the answers

In the context of diabetes management, which of the following would be classified under secondary prevention?

A diabetes screening exam Signup and view all the answers

The work of which early nursing leader emphasized the importance of community health nursing?

Lavinia Dock Signup and view all the answers

What does the Spirit function conceptual model of nursing emphasize?

The integration of mind, body, and spirit in healthcare Signup and view all the answers

Which domain is NOT included in the revised NONPF competencies for Nurse Practitioners?

Management of the therapeutic environment Signup and view all the answers

Which of the following best describes the role of the APRN according to Ryan's Integrated Theory of Health Behavior Change?

To facilitate and tailor interventions for health behavior change Signup and view all the answers

What significant aspect is included in Shuler's NP practice model?

Developing a holistic patient database Signup and view all the answers

What is a major characteristic of nurse coaching as described in the content?

Promotion of integrative approaches for health and well-being Signup and view all the answers

Which model emphasizes the impact of holistic thinking and contextual factors on nursing practice?

Ryan's Integrated Theory of Health Behavior Change Signup and view all the answers

What is a key challenge that has led to the reevaluation of traditional medical practices?

Advancements in technology overshadowing patient relationships Signup and view all the answers

In the context of pain management, which concept is highlighted as part of symptom management?

Subjective experience of symptoms Signup and view all the answers

Which of the following is NOT true regarding the core competencies outlined for Nurse Practitioners?

Prioritizes ethical decision making Signup and view all the answers

What is a crucial element of the Circle of Caring model?

Holistic and individualized therapeutic plans Signup and view all the answers

Study Notes

Scope of Practice and Future Directions

Scope of practice varies by state; future success hinges on nurses' involvement in practice, education, and leadership.
Increased diversity in the nursing workforce is essential for improved outcomes.
Enhanced data collection is necessary to monitor progress.
Healthy People 2030 requires extensive development.

Primary Care Definition

Primary care is continuous, person-centered, and relationship-based, reflecting the needs and preferences of individuals, families, and communities.

Core Competencies for APRNs

Knowledge for Nursing Practice
Person-Centered Care
Population Health
Scholarship for Nursing Practice
Quality and Safety
Interprofessional Partnerships
Systems-Based Practice
Information and Healthcare Technologies
Professionalism
Personal, Professional, and Leadership Development

Caring in Nursing

Caring embodies the intentional and authentic presence of nurses with patients.
Central to nursing, represented in the Circle of Caring Model: Courage, Authentic Presence, Advocacy, Knowing, Commitment, Patience.

Medicare Overview

Medicare is a health insurance program for individuals aged 65 and older, consisting of four parts: Part A (Hospital), Part B (Medical), Part C (Medicare Advantage), and Part D (Pharmaceutical).
To bill Medicare, providers must enroll and obtain a National Provider Identifier (NPI).
Medicare pays claims based on specified services, charging patients a 20% copay for certain services.

Medicare Part D Details

Established in 2003, offers coverage for prescription drugs not included in Medicare A or B.
The "donut hole" is a coverage gap starting after reaching the initial coverage limit; in 2021, this limit was $4,120.
Catastrophic coverage kicks in after out-of-pocket expenses reach $6,350, reducing copays to 5%.

Medicare Advantage Plans

Offer integrated coverage for Medicare A and B, often including extra benefits like dental and vision.
Must adhere to CMS requirements and generally involve lower costs through volume discounts.
Types include HMO, PPO, PFFS, and SNP plans.

Medicaid Overview

Provides medical assistance to low-income individuals and families, funded by both federal and state governments.
Eligibility focuses on children, pregnant women, parents, seniors, and disabled individuals, determined by Modified Adjusted Gross Income (MAGI).
In 2020, Medicaid and CHIP provided coverage to over 72.5 million Americans.

HIPAA Regulations

HIPAA consists of Title I (insurance coverage protection) and Title II (administrative simplification and security of health data).
Establishes national standards for electronic healthcare transactions and privacy.
Essential for practice management including security measures like password protection and workstation security.

Levels of Prevention in Healthcare

Primary Prevention: Immunizations, health education, lifestyle modifications.
Secondary Prevention: Screenings for early disease detection.
Tertiary Prevention: Treatment aimed at reducing disease complications.

Historical Development in Nursing

Florence Nightingale's principles of health and sickness.
Lavinia Dock's community health nursing model.
Virginia Henderson's emphasis on health in living environments.
Evolution of nursing protocols stems from early school nurses and public health efforts.

Key Nursing Models and Concepts

Benner's "From Novice to Expert" shaped NP curricula.
Swanson's conceptual model emphasizes the spirit's role in nursing.
Shuler's holistic approach includes diverse dimensions of patient care.

The Circle of Caring Model

Focuses on individualized care plans encompassing holistic approaches to treatment.
Outcomes assessed based on patient perceptions and quantitative measures.
Recognition of "calls for nursing" prioritizing caring as essential in nursing practice.

Importance of Caring in Nursing

Caring is foundational to nursing, distinguishing it from other health professions.
Engenders meaningful patient-nurse relationships through qualities like courage, commitment, and advocacy.
Emphasizes a balance between medical interventions and compassionate care tailored to individual needs.

Scope of Practice and Future Success

Scope of practice for nurses varies by state, impacting roles and responsibilities.
Future success hinges on three main themes: full participation of nurses in practice, education, and leadership; diversity within the nursing workforce; and improved data collection for evaluating progress.
Healthy People 2030 initiative requires significant efforts to achieve its objectives.

Definition of Primary Care

Primary care is characterized as continuous, person-centered, and relationship-based care, prioritizing the individual’s needs and preferences.

Core Competencies for Advanced Practice Registered Nurses (APRNs)

Knowledge for Nursing Practice
Person-Centered Care
Population Health
Scholarship for Nursing Practice
Quality and Safety
Interprofessional Partnerships
Systems-Based Practice
Information and Healthcare Technologies
Professionalism
Personal, Professional, and Leadership Development

Caring in Nursing

The practice of caring is crucial in nursing, incorporating authentic presence and intentionality.
The Circle of Caring Model highlights essential elements: Courage, Authentic Presence, Advocacy, Knowing, Commitment, and Patience.

Medicare Overview

Medicare offers health insurance for individuals aged 65 and older, consisting of four parts: A (hospital services), B (physician services), C (Medicare Advantage), and D (pharmaceutical coverage).
Medicare Part A: Covers inpatient hospital services, with a deductible of $1,484 in 2021; out-of-pocket costs include coinsurance for extended hospital stays.
Medicare Part B: Covers outpatient services; in 2021, the deductible was $203, with patients responsible for 20% of costs post-deductible.
Medicare Part D: Provides prescription drug coverage; includes a coverage gap known as the donut hole with specific out-of-pocket thresholds.
Medicare Advantage Plans: Offered by private insurers, these combine Part A and Part B coverage and may include additional benefits.

Medicaid

Medicaid assists low-income individuals and families, funded jointly by federal and state governments.
Eligibility determined by financial criteria, including Modified Adjusted Gross Income (MAGI) established by the ACA.
The program, along with CHIP, covered over 72.5 million Americans in 2020.

Health Insurance Portability and Accountability Act (HIPAA)

HIPAA comprises two main titles: Title I protects health insurance during job changes; Title II establishes standards for electronic healthcare transactions, focusing on data privacy and security.
HIPAA mandates secure information management practices, including password protection and worksite security.

Prevention Strategies

Primary Prevention: Immunizations, health education, lifestyle changes (e.g., weight control, seat belt use).
Secondary Prevention: Screenings for diseases like cancer and diabetes.
Tertiary Prevention: Interventions to mitigate progression of existing health issues.

Historical Perspectives in Nursing

Influential figures like Florence Nightingale emphasized foundational health laws and the importance of nursing practice.
Nursing practices have evolved with contributions from scholars like Lavinia Dock and Virginia Henderson, advocating for community health models and holistic health perspectives.

Nursing Models and Theories

Benner's "From Novice to Expert" framework supports NP curricula development.
Integrated theories, such as Ryan's ITBHC, highlight the role of APNs in promoting health behavior changes among clients.
Various nursing models stress holistic patient assessment, collaborative care, and the significance of addressing emotional and psychological health.

Changing Healthcare Delivery Models

Modern healthcare faces a shift towards a balance between curative and caring practices, prompted by technological advances and the need for holistic approaches.
The Circle of Caring emphasizes a patient-centered therapeutic plan that considers both traditional and complementary interventions, focusing on patient, family, and community outcomes.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Explore the key themes and core competencies outlined in the first chapter of the nursing scope of practice. This quiz emphasizes the importance of diverse nursing roles, effective leadership, and the need for better data to assess progress in healthcare. Test your understanding of primary care principles as defined in Healthy People 2030.