Podcast
Questions and Answers
What attribute of caring is defined as being deeply attuned through intentional and authentic presence?
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?
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?
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?
What does 'authentic presence' in nursing primarily involve?
What is a hallmark of a broadened approach to therapeutics and interventions in nursing?
What is a hallmark of a broadened approach to therapeutics and interventions in nursing?
What is a primary reason Medicare Advantage plans have become less financially viable?
What is a primary reason Medicare Advantage plans have become less financially viable?
What type of Medicaid eligibility method was established by the ACA?
What type of Medicaid eligibility method was established by the ACA?
Which of the following is NOT a common type of Medicare Advantage plan?
Which of the following is NOT a common type of Medicare Advantage plan?
Who jointly funds Medicaid programs?
Who jointly funds Medicaid programs?
Which group is exempt from meeting the MAGI requirements for Medicaid eligibility?
Which group is exempt from meeting the MAGI requirements for Medicaid eligibility?
What happens if a Medicare Advantage plan's payout exceeds the fixed annual payment from CMS?
What happens if a Medicare Advantage plan's payout exceeds the fixed annual payment from CMS?
What is a benefit of Medicare Advantage plans for beneficiaries regarding out-of-pocket expenses?
What is a benefit of Medicare Advantage plans for beneficiaries regarding out-of-pocket expenses?
What is a common problem faced by Medicare Advantage plans?
What is a common problem faced by Medicare Advantage plans?
What is the primary definition of primary care?
What is the primary definition of primary care?
Which of the following is NOT one of the core competencies for APRNs?
Which of the following is NOT one of the core competencies for APRNs?
Which element is included in the CIRCLE OF CARING MODEL?
Which element is included in the CIRCLE OF CARING MODEL?
What is meant by the term 'scope of practice' in nursing?
What is meant by the term 'scope of practice' in nursing?
Which aspect is essential for the future success of nursing?
Which aspect is essential for the future success of nursing?
What is the purpose of Medicare's National Provider Identifier (NPI)?
What is the purpose of Medicare's National Provider Identifier (NPI)?
Which domain emphasizes the importance of leadership in nursing practice?
Which domain emphasizes the importance of leadership in nursing practice?
What is one of the elements included in the diagnostic process?
What is one of the elements included in the diagnostic process?
What percentage of the approved Medicare rate is a patient charged for physician office visits after payment?
What percentage of the approved Medicare rate is a patient charged for physician office visits after payment?
Why is it important to collect patient out-of-pocket payments before rendering services?
Why is it important to collect patient out-of-pocket payments before rendering services?
What is the initial coverage limit for Medicare D in 2021?
What is the initial coverage limit for Medicare D in 2021?
What occurs when a Medicare beneficiary's out-of-pocket expenses reach $6,350?
What occurs when a Medicare beneficiary's out-of-pocket expenses reach $6,350?
What is one main advantage of Medicare Advantage plans?
What is one main advantage of Medicare Advantage plans?
What is the purpose of the donut hole in Medicare D drug coverage?
What is the purpose of the donut hole in Medicare D drug coverage?
Medicare Advantage plans must offer which of the following?
Medicare Advantage plans must offer which of the following?
How does the requirement for providers to collect copayments and deductibles affect their operations?
How does the requirement for providers to collect copayments and deductibles affect their operations?
What does Title I of HIPAA primarily address?
What does Title I of HIPAA primarily address?
Which of the following is NOT considered a primary prevention method?
Which of the following is NOT considered a primary prevention method?
Which component is essential in managing patient health/illness status according to revised NONPF competencies?
Which component is essential in managing patient health/illness status according to revised NONPF competencies?
Which of the following best describes tertiary prevention?
Which of the following best describes tertiary prevention?
What is the main focus of the nurse coaching approach?
What is the main focus of the nurse coaching approach?
What was a key contribution of Virginia Henderson to nursing?
What was a key contribution of Virginia Henderson to nursing?
In Ryan's Integrated Theory of Health Behavior Change, what role do Advanced Practice Nurses (APNs) play?
In Ryan's Integrated Theory of Health Behavior Change, what role do Advanced Practice Nurses (APNs) play?
What is a major aspect of symptom management as described in the content?
What is a major aspect of symptom management as described in the content?
Which factor contributed to the reevaluation of traditional medical roles?
Which factor contributed to the reevaluation of traditional medical roles?
What does the Circle of Caring emphasize in nursing practice?
What does the Circle of Caring emphasize in nursing practice?
Which nursing model emphasizes the importance of a holistic patient database?
Which nursing model emphasizes the importance of a holistic patient database?
Which of the following roles is part of the revised 7 domains for nurse practitioners?
Which of the following roles is part of the revised 7 domains for nurse practitioners?
Which aspect does NOT fall under the category of administrative simplification in Title II of HIPAA?
Which aspect does NOT fall under the category of administrative simplification in Title II of HIPAA?
What preventative screening is classified under secondary prevention?
What preventative screening is classified under secondary prevention?
Which core competency emphasizes the importance of quality and safety in nursing practice?
Which core competency emphasizes the importance of quality and safety in nursing practice?
Which element in the CIRCLE OF CARING MODEL symbolizes the dedication to persistent support for patients?
Which element in the CIRCLE OF CARING MODEL symbolizes the dedication to persistent support for patients?
What is required for providers to bill Medicare for their services?
What is required for providers to bill Medicare for their services?
What primarily defines primary care in the provided context?
What primarily defines primary care in the provided context?
Which of the following themes is crucial for the future success of nursing practice?
Which of the following themes is crucial for the future success of nursing practice?
When billing Medicare for services, what must providers agree to accept?
When billing Medicare for services, what must providers agree to accept?
Which of these elements is NOT part of the diagnostic process?
Which of these elements is NOT part of the diagnostic process?
What is one of the primary goals of the Healthy People 2030 initiative?
What is one of the primary goals of the Healthy People 2030 initiative?
What is one of the major financial challenges faced by Medicare Advantage plans?
What is one of the major financial challenges faced by Medicare Advantage plans?
Which statement best describes the funding structure for Medicaid?
Which statement best describes the funding structure for Medicaid?
Under the Affordable Care Act (ACA), which income assessment method is used for Medicaid eligibility?
Under the Affordable Care Act (ACA), which income assessment method is used for Medicaid eligibility?
What can beneficiaries of Medicare Advantage plans do regarding noncovered services?
What can beneficiaries of Medicare Advantage plans do regarding noncovered services?
Which common type of Medicare Advantage plan is focused on requiring members to use a network of providers?
Which common type of Medicare Advantage plan is focused on requiring members to use a network of providers?
Which group is generally NOT included in the financial eligibility criteria for Medicaid benefits?
Which group is generally NOT included in the financial eligibility criteria for Medicaid benefits?
What might happen if a Medicare Advantage plan's annual payout exceeds the payment received from CMS?
What might happen if a Medicare Advantage plan's annual payout exceeds the payment received from CMS?
What role does the Children’s Health Insurance Program (CHIP) play alongside Medicaid?
What role does the Children’s Health Insurance Program (CHIP) play alongside Medicaid?
What was the Medicare Part A deductible in 2021?
What was the Medicare Part A deductible in 2021?
What percentage of the physician fee is covered by CMS for NP services?
What percentage of the physician fee is covered by CMS for NP services?
How much does a patient pay for hospital stays from days 61 to 90 under Medicare?
How much does a patient pay for hospital stays from days 61 to 90 under Medicare?
What is the maximum number of lifetime reserve days a Medicare beneficiary can use?
What is the maximum number of lifetime reserve days a Medicare beneficiary can use?
What was the Medicare B deductible for the year 2021?
What was the Medicare B deductible for the year 2021?
What is the copayment for days 21 to 100 in a skilled nursing facility under Medicare?
What is the copayment for days 21 to 100 in a skilled nursing facility under Medicare?
What strategy is reflected in the Medicare Physician Fee Schedule as of 2021?
What strategy is reflected in the Medicare Physician Fee Schedule as of 2021?
How much do beneficiaries typically pay out of pocket for their secondary insurance plan?
How much do beneficiaries typically pay out of pocket for their secondary insurance plan?
What is the primary responsibility of Medicare beneficiaries regarding their out-of-pocket payments before receiving services?
What is the primary responsibility of Medicare beneficiaries regarding their out-of-pocket payments before receiving services?
What happens when a Medicare beneficiary's expenses exceed the initial coverage limit for Medicare D in a given year?
What happens when a Medicare beneficiary's expenses exceed the initial coverage limit for Medicare D in a given year?
Which of the following is a key feature of Medicare Advantage plans?
Which of the following is a key feature of Medicare Advantage plans?
Why is the 'donut hole' a significant aspect of Medicare D coverage?
Why is the 'donut hole' a significant aspect of Medicare D coverage?
What is the required patient payment for physician office visits post initial payment under Medicare?
What is the required patient payment for physician office visits post initial payment under Medicare?
What does ACA legislation aim to do regarding the donut hole in Medicare D?
What does ACA legislation aim to do regarding the donut hole in Medicare D?
Which statement regarding patient billing practices is accurate?
Which statement regarding patient billing practices is accurate?
What defines catastrophic coverage in Medicare D for the year 2021?
What defines catastrophic coverage in Medicare D for the year 2021?
What is the primary objective of Title II of HIPAA?
What is the primary objective of Title II of HIPAA?
Which of the following is an example of tertiary prevention?
Which of the following is an example of tertiary prevention?
In the context of diabetes management, which of the following would be classified under secondary prevention?
In the context of diabetes management, which of the following would be classified under secondary prevention?
The work of which early nursing leader emphasized the importance of community health nursing?
The work of which early nursing leader emphasized the importance of community health nursing?
What does the Spirit function conceptual model of nursing emphasize?
What does the Spirit function conceptual model of nursing emphasize?
Which domain is NOT included in the revised NONPF competencies for Nurse Practitioners?
Which domain is NOT included in the revised NONPF competencies for Nurse Practitioners?
Which of the following best describes the role of the APRN according to Ryan's Integrated Theory of Health Behavior Change?
Which of the following best describes the role of the APRN according to Ryan's Integrated Theory of Health Behavior Change?
What significant aspect is included in Shuler's NP practice model?
What significant aspect is included in Shuler's NP practice model?
What is a major characteristic of nurse coaching as described in the content?
What is a major characteristic of nurse coaching as described in the content?
Which model emphasizes the impact of holistic thinking and contextual factors on nursing practice?
Which model emphasizes the impact of holistic thinking and contextual factors on nursing practice?
What is a key challenge that has led to the reevaluation of traditional medical practices?
What is a key challenge that has led to the reevaluation of traditional medical practices?
In the context of pain management, which concept is highlighted as part of symptom management?
In the context of pain management, which concept is highlighted as part of symptom management?
Which of the following is NOT true regarding the core competencies outlined for Nurse Practitioners?
Which of the following is NOT true regarding the core competencies outlined for Nurse Practitioners?
What is a crucial element of the Circle of Caring model?
What is a crucial element of the Circle of Caring model?
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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.
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