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A home health nurse is conducting an assessment of a patient who may qualify for Medicare. Consequently, the nurse is utilizing the Outcome and Assessment Instrument Set (OASIS). When performing an assessment using this instrument, the nurse should assess which of the following domains of the patients current status?
- A. Psychiatric status
- B. Spiritual state
- C. Compliance with care
- D. Functional status
Correct Answer: D
Rationale: The Omaha System of care documentation has been required for over a decade to assure that outcome-based care is provided for all care reimbursed by Medicare. This system uses six major domains: sociodemographic, environment, support system, health status, functional status, and behavioral status and addresses selected health service utilization. It does not explicitly assess spirituality, psychiatric status, or compliance with care.
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An urban, community-based nurse is looking for community resources for a patient who has complex rehabilitation needs coupled with several comorbid, chronic health conditions. Where is the best place for the nurse to search for appropriate resources?
- A. A hospital directory
- B. The hospital intranet
- C. A community directory
- D. The nurses own personal network
Correct Answer: C
Rationale: Most communities have directories of health and social service agencies that the nurse can consult. The other answers are incorrect because hospital directories and intranets usually only include people affiliated with the hospital. The nurses personal network of contacts may or may not be of use.
A home health nurse is preparing to make the initial visit to a new patients home. When planning educational interventions, what information should the nurse provide to the patient and his or her family?
- A. Available community resources to meet their needs
- B. Information on other patients in the area with similar health care needs
- C. The nurses contact information and credentials
- D. Dates and times of all scheduled home care visits
Correct Answer: A
Rationale: The community-based nurse is responsible for informing the patient and family about the community resources available to meet their needs. During initial and subsequent home visits, the nurse helps the patient and family identify these community services and encourages them to contact the appropriate agencies. When appropriate, nurses may make the initial contact. The other answers are incorrect because it is inappropriate to ever provide information on other patients to a patient. The nurses credentials are not normally discussed. Giving the patient the dates and times of their scheduled home visits is appropriate, but may not always be possible. It is more important to provide them with resources available within the community to meet their needs.
A recent nursing graduate has been surprised at the sharp contrast between some patients lifestyles in their homes and the nurses own practices and beliefs. To work therapeutically with the patient, what must the nurse do?
- A. Request another assignment if there is dissonance with the patients lifestyle.
- B. Ask the patient to come to the agency to receive treatment, if possible.
- C. Resolve to convey respect for the patients beliefs and choices.
- D. Try to adapt the patients home to the norms of a hospital environment.
Correct Answer: C
Rationale: To work successfully with patients in any setting, the nurse must be nonjudgmental and convey respect for patients beliefs, even if they differ sharply from the nurses. This can be difficult when a patients lifestyle involves activities that a nurse considers harmful or unacceptable, such as smoking, use of alcohol, drug abuse, or overeating. The nurse should not request another assignment because of a difference in beliefs, nor do nurses ask for the patient to come to the agency to receive treatment. It is also inappropriate to convert the patients home to a hospital-like environment.
A nursing student has taught a colleague that nursing practice is not limited to hospital settings, explaining that nurses are now working in ambulatory health clinics, hospice settings, and homeless shelters and clinics. What factor has most influenced this increased diversity in practice settings for nurses?
- A. Population shift to more rural areas
- B. Shift of health care delivery into the community
- C. Advent of primary care clinics
- D. Increased use of rehabilitation hospitals
Correct Answer: B
Rationale: As health care delivery shifts into the community, more nurses are working in a variety of community-based settings. These settings include public health departments, ambulatory health clinics, long-term care facilities, hospice settings, industrial settings (as occupational nurses), homeless shelters and clinics, nursing centers, home health agencies, urgent care centers, same-day surgical centers, short-stay facilities, and patients homes. The other answers are incorrect because our population has not shifted to a more rural base, and the use of primary care clinics has not influenced an increase in practice settings or the use of rehabilitation hospitals.
The nursing instructor is preparing a group of students for their home care rotation. In preparation, the group discusses the patients that they are most likely to care for in the home. Which of the following groups are the most common recipients of home care services?
- A. Mentally ill patients
- B. Patients receiving rehabilitation after surgery
- C. Terminally ill and palliative patients
- D. Elderly patients
Correct Answer: D
Rationale: The elderly are the most frequent users of home care services. The patient must be acutely ill, homebound, and in need of skilled nursing services to be eligible for this service. The other answers are incorrect because it is the elderly who are seen most frequently in the home health setting, though each of the other listed groups may sometimes receive home care.