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Exam1: Ambulatory Care Nurse Certification Questions and Answers
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- ElementseofeCCTM:e - Assumingeaccountability
- Providingepatientesupport
- Buildingerelationshipseandeagreementseamongeprovidersethateleadetoesharedeexpec- etationseforecommunicationeandecare
Developingeconnectivityeviaeelectroniceoreothereinformationepathwaysethateencourageetimelyeandeef fectiveeinformationeflowebetween
- Careecoordination:e NeedehighequalityereferraleoretransitioneShoulde beetimely Safe:eReferralseandetransitionseareeplannedeandemanagedetoepreventeharmetoepatientsefromemedicale oreadministrativeeerrors. Effective:ereferralseandetransitionseareebasedeonescientificeknowledgeePatientecentere d efficienteE quitable
- 6 eprincipleseofeCCTMeNusing:e Theseesixeprincipleseprovideeaebasiseforeestablish- eingeaneinformedeandecollaborativeecareecoordinationeprocessethateincludeseallestaff,ekeyestake holders,eandenurseeleaderseacrossetheecontinuumeofecare:
- Knowehowecareeisecoordinatedeineyouresetting
- Knowewhoeiseprovidingecare
Establisherelationshipsewithemultipleeentitieseandeindividualsewhoecaneworketogetheretoeimprove ecareecoordinationeandetransitionemanagementesystems
Knowetheevalueeofetechnology,eitseimpacteoneworkflow,eandetheeroleseofecareecoordinationeteamem embers
- Engageetheepatienteandefamily
- Engageealleteamememberseinecareecoordination
- TheelogicemodeleandeCCTM:e TheeLogiceModeledepictseprogrameoutcomes,ehowetheeprograme isesupposedetoeaccomplishetheseeoutcomeseandewhateisetheebasise(logic)eforetheseeexpectations. Linkseprogrameinputse(resources)eandeactivitiesetoetheeprogrameproductseandeout- ecomesewhileecommunicatingetheelogic Components: Inputs:eresourcesethategoeintoetheeprogrameActivities:eactua leeventseoreactionsethatetakeeplaceeProducts:edirectetangiblee outputeofeprogrameactivities Outcomes:eimpacteofetheeprogram;etheesequenceeofeeffectsetriggeredebyetheeprogram,eofteneexpres sedeinetermseofeshorteterm,eintermediate,eandedistaleoutcomes
inteofeaccess;
aemisconceptionethatecareetransitionseoriginateewitheaehospitalizationeratherethanerecognizingeth eemultipleecareetransitionseoccurringeamongediverseeambulatoryecareesettings;
aemisconceptionethateaemeasureeofecareecoordinationeandetransitionemanagementeisehandingep atientsewritteneinstructionseprioretoedischarge,eaesingleeinterventioneof
aehand- offebutenoteaemeasureeofeperformanceeofecareebeingecoordinatedeoretheetransitionebeingemanaged ;
aemisconceptionethatecareecoordinationeandetransitionemanagementeareediscreteepointseofecom municationeratherethaneaecontinuouseconversationewitheongoingecom-emunication;
- aemisconceptionethateindividualsewithecomplexehealthecareeneedseareeequippedewitheself- managementeskillseandedecision- makingeskillsetoeknowewhatetoedoewhenetheireconditioneworsenseoretheyedevelopeaecomplication
aemisconceptionethateindividualsewithecomplexehealthecareeneedseseekecareeinetraditionaleprimar yecareesettings,ewhenediverseeambulatoryesettingseareeservingevulnerableepopulationseincludingeu ninsured,eMedicaid,eandegeographicallyeandeeco-enomicallyedisadvantaged.
- 3 eGeneralecontextseofeambulatoryecareenurses::e - episodic/preventativeecare
- chronicediseaseemanagement
- practiceeoperations
- Episodic/preventativeecare:e - Teletriage
- Medicationerecon
- Promoteeadherenceetoetreatment
- HPI/patientehealthestatuse-eflagekeyefindingseforeprioritization
- Chronicediseaseemanagement:e - Telecommunication
- Dischargeestrategiese-ebettereeducation
- Earlyeidentificationeofesx
- PracticeeOperations:e - Guideeteletriage
- QIeDataeanalysisepracticeeleadership
- Prioritizingepatienteappointmenteaccesseandeserviceecoordination RNeskillsewereeviewedeasevitaletoemanageepatientefloweandecapacity,eenhanceesameedayecareeneed s,eandeaccommodateeafterehoursescheduling
- TrainedeandesupervisedeLPNseandeMAs
- Directedecommunityebasedeteams
- Managedepatientenavigationecenters
vices,ewhicheincludesedefiningetheeappropriateeskillemixeandedelegationeofetaskseamongelicensede andeunlicensedehealthecareeworkers.
- RNseareefullyeaccountableeinealleambulatoryecareesettingseforeallenursingeserviceseandeassociatede patienteoutcomeseprovidedeunderetheiredirection.
- Keyeelementseofeambulatoryecareenursing::
- Clientsewhoeareehelpedemostebyecareecoordination::e - Chronicallyeillepatients
- SomeoneewhoedoesntehaveeeffectiveePCPe-emanyeEDevisits Whoeisefailedebyeprimaryecare?eTheequestioneiseposedethisewayebecauseeweecaneviewemostehospitali zationseasefailureseofepreventiveeprimaryecare. Aeblunteassessmentecanebeeaesimpleescaneofetheemostefrequenteuserseofehospi- tal-basedeservicese— ethateis,eindividualsewhoevisitetheeemergencyeroomefrequentlyeandewhoseeillnesseseoftenewarran teinpatientecare. Frequenteuseeisedefinededifferentlyeinedifferentehospitalesettings;esomeehospitalsesimplyefocuse onethoseewhoemadeethreeeoremoreeemergencyeroomevisitseinetheepasteyear,ewhileeothersedefinee" frequent"easefiveeoremoreeemergencyedepartmentevisitseinetheepasteyear,eandestilleothersereviewe billedeanderecoupedechargesetoeidentifyethee 10 eore 20 emosteexpensiveepatients. Sophisticatedepredictiveemodelingecanefurthereidentifyeindividualsewhoeareelikelyetoedriveehigh efutureehealthecareecosts,easedistinctefromethoseewhoseeillnesseserequireeacuteecareeforeaegive neepisode. Aneassessmenteofeambulatory- sensitiveeadmissionseiseanotherewayetoeidentifyethoseewhoecouldebenefitefromebetterecoordinate decareeandecaneindicateeinadequateeaccessetoeprimaryecare.eSeeetheeCommonwealtheCareeAllia nceemethodeonepagee 9 easeaneexampleeofeeffectiveeidentificationeandestratificationeofepatients.
- Assumingeaccountability:e Referralseareemoreelikelyetoebeesuccessfuleifereferringeprovidersea ndeconsultantseunderstandeeacheother'seexpectationseandepreferences,eandereferringepractice sehaveetheestaffeandeinformationeinfrastructureetoehelpepatientseandetheireinformationegetewhere etheyeneedetoego Patientseandetheirefamiliesecanehelpeensureeeffectiveeandeefficientereferralseifetheyeareeadequatelyei nformedeandesupportedetoeplayeaneactiveerole.
PCMHsemustetryetoeworkewitheareaehospitalseandeERsetoeincreaseetheelikelihoodethatetheyewillere ceiveetimely,eusefuleinformationewhenetheirepatientseareeadmittedeandedischarged. Aneimportantecomponenteofeassumingeaccountabilityeisehavingetheeabilityetoetrackereferralseandetr ansitionsetoeassureetheiresuccessfulecompletion.
- Providingepatientesupport:e Referralecoordinatoreshouldehelpebyeidentifyingeanyelogisticaleor efinancialebarriers Helpsegetsetimelyeappointments
10 e/e 27 Diseaseemodel: Diseaseeofebraine- eoutsideevoluntaryecontrolePrevailingemedicalemodel- ebasedeonemedicalemodel
11 e/e 27 Bio-psycho-social-spiritualemodel: Mostereflectiveeofeholisticeperspectiveeofenursinge 12 este peandediseaseemodels Intertwinedewithespiritual
- Applyeprincipleseofecareecoordinationetoespecificeclientechallenges.eHowewouldeaecaree coordinatorebeeableetoehelpeaeparticularecomplexeclient?:e Primaryeandeacuteecommunicating
- MoreecomprehensiveeEMResystemetoepromoteecontinuityeofecare
- Referraletoespecialistseandesimplifyingeissues
- Ensuringeresourceseareeavailableefirst
- Transportation,etelephone,ehealthyefood,ehome,
- Simplifyecomplexityeofesystem Transitionecoaches Bridgeecareeafterehospitaledischarge Careecoordinator Promoteeselfemanagement,epatienteadvocacyeCorrecte assignmentebasedeoneskillset ReimbursementefromeMedicare
- *****KnowetheeelementseofetheeNIHeCleareandeSimpleeCommunicationseprocesseandebee ableetoeapplyethemetoeaeclinicaleexample.:e** 5 eStepseforeCleareandeSimpleecommunication:
- Determine/defineetargeteaudience,eassesselearningestyle
- Targeteaudienceeresearch,eassesserumors/mythseandemisinfo,edetermineefeelings,efilleinegapse ineinfo
- Developeconcepteforeproduct,euseeinfoefromeaudienceeresearchetoeoutlineeobjec- etives/style/format/approach,eputtingeitetogether
- Developecontent,evisualedefinedefeatures,etailoredetoeneedseofeaudienceetoeliteracy
- Pre- testeorereviseedraftematerials,emeasureeresponseeofeaudienceetoeproduct,emeasureetheirec omprehension
13 e/e 27 locatingeeasilyeidentifiableeinformationeineshort,ecommonplaceeproseetextselocatingee asilyeidentifiableeinformationeandefollowingewritteneinstructionseinesimpleedocuments e(e.g.,echartseoreforms) locatingenumberseandeusingethemetoeperformesimpleequantitativeeoperationse(primarilyea ddition)ewhenetheemathematicaleinformationeiseveryeconcreteeandefamiliar CircleetheedateeShortei nstructions ClearlyewrittenepamphletePri maryeadditione-e1+1= Identifyehoweofteneaepersoneshouldehaveeaespecifiedemedicaletest,ebasedeoneinforma- etioneineaeclearlyewrittenepamphlet.
- Intermediate:e - Majorityeofeadultsehadeintermediateehealtheliteracy
readingeandeunderstandingemoderatelyedense,elessecommonplaceeproseetextseasewelleasesumma rizing,emakingesimpleeinferences,edeterminingecauseeandeeffect,eand ---recognizingetheeauthor'sepurpose
locatingeinformationeinedense,ecomplexedocumentseandemakingesimpleeinferenceseaboutetheeinfo rmation
elocatingelessefamiliarequantitativeeinformationeandeusingeitetoesolveeproblemsewhenetheearithmeti ceoperationeisenotespecifiedeoreeasilyeinferred readingeandeunderstandingemoderatelyedense,elessecommonplaceeproseetextseasewellease summarizing,emakingesimpleeinferences,edeterminingecauseeandeeffect,eanderecognizinget heeauthor'sepurpose locatingeinformationeinedense,ecomplexedocumentseandemakingesimpleeinferenceseaboutetheeinf ormation locatingelessefamiliarequantitativeeinformationeandeusingeitetoesolveeproblemsewhenetheeari thmeticeoperationeisenotespecifiedeoreeasilyeinferred
14 e/e 27
- OTCemedeinteractions
- Readeaeprescriptionelabel
- Chartedeterminede BMI
- Ageerangeevaccinations
- Proficient:e - readingelengthy,ecomplex,eabstracteproseetextseasewelleasesynthesiz- eingeinformationeandemakingecomplexeinferences
integrating,esynthesizing,eandeanalyzingemultipleepieceseofeinformationelocatedeinecomplexedocu ments
Documenteexampleseincludeejobeapplications,epayrolle forms,etransportationeschedules,emaps,etables,eandedr ugeandefoodelabels. Quantitativeeliteracy.eTheeknowledgeeandeskillserequiredeto eperformequantitativeetaskse(i.e.,etoeidentifyeandeperformeco mputations,eeitherealone
oresequentially,eusingenumberseembeddedeineprintedem aterials).eExampleseincludeebalancingeaecheckbook,efig uringeouteaetip,ecompletingeaneordereform,eandedetermin ingetheeamounteofeinteresteoneaeloanefromeaneadvertisem ent.
- Basic:e readingeandeunderstandingeinformationeineshort,ecommonplaceeproseetexts readingeandeunderstandingeinformationeinesimpleedocuments locatingeeasilyeidentifiableequantitativeeinformationeandeusingeitetoesolveesimple,eone- stepeproblemsewhenetheearithmeticeoperationeisespecifiedeoreeasily inferred indicateseskillsenecessaryetoeperformesimpleeand eeverydayeliteracyeactivities Explainewhyeiteisedifficulteforepeopleetoeknoweifetheyehaveeaespecificechronicemedicalecondition,eba sedeoneinformationeineaeone- pageearticleeaboutetheemedicalecondition.eGiveetwoereasonseaepersonewithenoesymptomseofeaespeci ficediseaseeshouldebeetestedeforetheedisease,ebasedeoneinformationeineaeclearlyewrittenepamphlet.
- MotivationaleInterviewingeAcronym:e R-eresistetheerightingereflexe-- edontetellethemetheyreewronge-eshutedown Ue-eUnderstandept'seownemotivations,eLe- eListenewitheempathy Ee-eEmpoweretheepatient Oe-eopeneendedequestionseAe- eaffirming Re-ereflectiveelistening Se-esummarizing
- Motivationaleinterviewingeprinciples:e 1.eAskingepermission:eCommunicateserespectefo reclients.eAlso,eclientseareemoreelikelyetoediscussechanging wheneasked,ethanewhenebeingelecturedeorebeingetoldetoechange.
- Openeendedequestions
- Reflectiveelisteninge-
- Normalizinge-emanyepeopleefeelethiseway
- Decisionalebalancinge- eToerealizeethate(a)etheyegetesomeebenefitsefrometheirerisky/problem behavior,eande(b)ethereewillebeesomeecostseifetheyedecideetoechangeetheirebehavior.epros/cons
- ColumboeApproach:edeployingediscrepancies "Onetheeoneehandeyou'reecoughingeandeareeoutebreath,eandeonetheeotherehandeyoueareesaying cigaretteseareenotecausingeyoueanyeproblems.eWhatedoeyouethinkeisecausingeyourebreathing difficulties?"
- Statementsesupportingeselfeefficacye-eaffirmation
- Readinessetoechangeeruler
- Advice/feedbacke-efactseabouteoutcomes "Soeyouesaideyoueareeconcernedeaboutegainingeweighteifeyouestopesmoking.eHowemuchedo youethinketheeaverageepersonegainseinetheefirsteyeareafterequitting?"
- Summary/mirroring
- Therapeuticeparadoxe- eParadoxicalestatementseareeusedewitheclientseineaneeffortetoegetethemetoeargueeforethe importanceeofechanging. "Bill,eIeknoweyouehaveebeenecomingetoetreatmenteforetwo months,ebuteyoueareestilledrinkingeheavily,emaybeenoweisenotetheerightetimeetoechange?")
- Precontemplation- enoteready:e PeopleeinetheePrecontemplationestageedoenoteintendetoetakeeactioneinetheeforeseea bleefuture,eusuallyemeasuredeasetheenextesixemonths.eBeingeuninformedeoreundereinformedeabo utetheeconsequenceseofeone'sebehavioremayecauseeaepersonetoebeeinetheePrecontemplationesta ge.eMultipleeunsuc- ecessfuleattemptseatechangeecaneleadetoedemoralizationeaboutetheeabilityetoechange.eBothetheeu ninformedeandeundereinformedetendetoeavoidereading,etalking,eorethinkingeaboutetheirehigh- riskebehaviors.eTheyeareeoftenecharacterizedeineotheretheorieseaseresistant,eunmotivated,eoreun readyeforehelp.eTheefacteis,etraditionaleprogramsewereenotereadyeforesucheindividualseandewereen otedesignedetoemeetetheireneeds.
Noeintentioneforeactionewithine 6 emos
- Contemplatione- egettingeready:e Contemplationeisetheestageeinewhichepeopleeintendetoechangeeinetheenextesixe months.eTheyeareemoreeawareeofetheeproseof
