How does acuity increase the demand for more nurses in the health care environment ? What is the difference between the scope of practice of an RN and an LVN ? Where do you get a copy of the scope of practice for an LVN/LPN ?
How are these roles indicated in the state’s scope of practice for the licensed practical/vocational nurse? What is the role of the LPN/LVN regarding working with other health care providers, such as nursing aides, registered nurses, physical therapists? How does the LVN/LPN advocate for the patient in your specific work environment?
Give examples of how the LVN/LPN can delegate a specific task. Give examples of how the LVN/LPN can assign a specific task. Can an LVN/LPN become a charge nurse? Under what circumstances?
Based on the five rights of delegation, identify a specific task that the LVN/LPN can delegate to the nursing assistant. How do you ensure that the task delegated is completed? Can an LVN/LPN delegate to another LVN/LPN? Can an LVN/LPN delegate to a registered nurse?
What are some of the considerations in making patient assignments in your work setting? How are disputes regarding patient assignments resolved in the work settings? Identify specific situations that warrant a change in patient assignment during the shift.
What is included in the job description of the nursing assistant in the work setting? If a patient states that the morning bath really isn’t wanted right now, what are some of the appropriate actions by the nursing assistant? The nursing assistant assists with personal hygiene, performs ordered treatments, initiates nursing interventions, and administers medications. The LVN/LPN would question which action by the nursing assistant?
Differentiate delegation from assignment? Delegation is transferring to competent unlicensed assistive personnel (UAP) the authority to perform a selected nursing task/activity in a selected patient situation that is within the job description of the LPN/LVN. To assign is to direct a UAP to do nursing tasks/activities within his/her job description.
Delegation is a voluntary function. Not all states allow LPN/LVNs to delegate nursing tasks/activities and state nurse practice acts (NPAs) vary greatly concerning delegation.
Provider = A licensed health care provider such as a physician, dentist, or nurse practitioner whose health care services are covered by a health insurance plan Compare and contrast deductible, co-payment, and co-insurance? Deductible = The yearly amount an insured person must spend out-of-pocket for health care services before a health insurance policy will begin to pay its share Co-payment = The amount an insured person must pay at the time of an office visit, prescription, or hospital service Co-insurance = Once a deductible is met, the percent of the total bill paid by the insured person. The insurance company pays the remainder Capitation = An alternative for fee-for-service payment; it involves a set monthly fee charged by the provider of health care services for each member of the insurance group for a specific set of health care services
Explain: “The young and the healthy generally subsidize (support) the sick and older persons in the health insurance group.” What is “third-party coverage”? Third-party coverage = A financial middleman who pays the individual's health care bills What is the utilization review system? How is it utilized to manage health care costs?
Point of service (POS) option allows a member to go outside the HMO to see a desired physician for an extra fee . List the advantages and disadvantages of the health maintenance organization. Is this a cost-effective system?
List the advantages and disadvantages of the preferred provider organization. Is this a cost-effective system?
Medicare Federal program that helps to partially finance health care for all persons over age 65 years (and their spouses), who have at least a 10-year (40 quarters) record in Medicare-covered employment Citizens or permanent residents of the United States Under age 65 who are victims of end-stage renal disease or who are permanently and totally disabled What are the ethical implications of Medicare?
What is a deductible? What are the advantages and disadvantages of prescription drug coverage?
What is a “fee-for-service” program? What are the advantages and disadvantages of extended health coverage?
Define “dual eligible.” Medicaid = State budgets and covers over 39 million low-income children and parents in working families Compare and contrast Medicare and Medicaid.
What are the ethical implications of cost-containment? What is Healthy People 2010? Healthy People 2010 is a nationwide health promotion and disease prevention agenda to improve the health of all Americans in the United States during the first decade of the 21st century. It includes a set of health objectives based on best scientific knowledge. Healthy People 2010 has the potential to affect the health of all Americans and reduce health care costs. What is holistic care? Holistic care involves dealing with the total person. Nurses need to be aware of the physiologic, psychological, social, cultural, and spiritual needs of patients.
How can the nurse help achieve the ten leading health indicators?
Empathy means the nurse accurately perceives the patient’s current feelings and their meanings but does not experience the emotion with them. Differentiate between a therapeutic nurse-patient relationship with a social relationship. The focus of the nurse-patient relationship is the patient and his/her problems and needs. The relationship is therapeutic because it provides the help needed for healing or return to wellness of the patient. A social relationship is not goal-directed, exists primarily for pleasure, and meets the needs of each person in the relationship. What is the importance of nurse competence? Nurses, who are competent in their skills, build patient’s confidence and this decreases patient anxiety.
What are the characteristics of a patient with dependent behavior? Unreasonably demanding of the nurse's time and attention Show little or no initiative in performing the simplest of self‑care activities Exhibit flirtatious behavior to attract attention to self
What are the characteristics of the patient with withdrawn behavior? May exhibit silence Failure to make eye contact Recoiling from touch Superficial conversation without any self‑disclosure or sharing of feelings Denial of feelings Denial of reality such as their own illness and its effects on their lives
What are the characteristics of the patient with depressed behavior? Loss of appetite, fatigue Vague aches and pains Insomnia Poor posture Gazing into space and difficulty making decisions
A nursing assistant demonstrates upbeat behavior while dealing with a patient with depressed behavior. How would you approach the situation to provide a therapeutic environment for the patient? How would you determine the seriousness of a patient’s threat of suicide? A patient was diagnosed with a terminal disease. How would you approach the patient?
What are the characteristics of a patient with hostile behavior? The patient with hostile behavior may shout, criticize, threaten to &quot;report&quot; the nurse, and constantly complain about the care provided. Some may strike out physically. Some may turn anger towards themselves and may attempt to hurt themselves. A nurse indicated that the patient with hostile behavior would be discharged by the physician before the end-of-the shift. As an incoming nurse, you realized that the physician opted to keep the patient for at least one more night. How would you approach the patient? The family expressed dissatisfaction with the care of their loved one. How would you, the nurse, help alleviate the mounting frustration and potential for a hostile reaction by a family member?
What are the characteristics of patients with manipulative behavior? A patient compliments the nurse for being attentive to the patient’s needs. List appropriate nursing actions. A patient reminds you of someone you know personally. How would this affect your nursing care?
The nurse is beginning to demonstrate defensive behaviors toward the patient. List appropriate nursing actions to alleviate the nurse’s mounting frustration or anger. While juggling admissions and discharges during a busy shift, how could a nurse meet the needs of the patient with manipulative behavior? The patient said, “If you do not do this for me, I will kill myself.” What are appropriate nursing actions?
Discuss how the nurse meets the social, cultural, and spiritual needs of the patients in an acute care setting. Give examples of judgmental behaviors you observed during your clinical rotations. Define “stereotype.” A stereotype is a simplification used to describe all members of a specific group without exception. Compare and contrast spirituality and religion.
Transfer to competent unlicensed assistive personnel (UAP) the responsibility to perform a selected nursing task/activity in a selected patient situation that is within the job description of the LPN/LVN.
Requires a deductible and pays 80% of most covered charges
The patient is responsible for the remaining 20%
For medically necessary health services
Does not pay for most prescription drugs, routine physicals, services not related to treatment of illness or injury, dental care, dentures, cosmetic surgery, routine foot care, hearing aids, eye examinations, or glasses