The nurse educator trains case managers on the use of an ...

[tatyanajohnson]

The nurse educator trains case managers on the use of an electronic medical record when providing client care. Which participant statements indicate that training has been effective?
 
  Select all that apply.
  A) The record reduces the cost of health care.
  B) The record allows trending of client progress.
  C) Client education is to be documented in the system.
  D) Quality metrics can be observed to reduce readmission rates.
  E) Coordination of care is improved.

Question 2

A client with terminal cancer has signed an advance directive indicating that no parenteral nutrition or hydration will be implemented.
 
  For several days the client has refused food and fluids, pushing the caregiver's hands away when attempts are made to feed the client or offer any kind of fluid. The family is considering placing a gastrostomy tube because they feel the client is starving to death. Which actions by the nurse are appropriate?
  Select all that apply.
  A) Take the case to the hospital's ethics committee.
  B) Honor the client's refusal of parenteral nutrition and hydration.
  C) Talk to the healthcare provider so the family's wishes can be acted upon.
  D) Help the family come to terms with the situation.
  E) Honor the family's wishes and have them sign a consent form.

[kjohnson]

Answer to Question 1

Answer: B, C, D, E

Electronic health records can assist the case manager by allowing trending of client progress, documentation of client education, and observation of quality metrics to help decrease readmission rates. Electronic health records also allow improved coordination of care between providers because they are all working off one chart. The use of the electronic health record does not directly reduce the cost of health care.

Answer to Question 2

Answer: B, D

A nurse is morally obligated to honor the refusal of food and fluids by a competent client who has signed an advance directive. This position is supported by the ANA's Code of Ethics for Nurses, through the nurse's role as a client advocate and through the moral principle of autonomy. Clients, not their families, should make decisions about their own health care and treatment. The physician may or may not be involved, but would not disregard the client's refusal. An ethics committee is usually considered when there is an ethical dilemma, and more input is needed to make a decision.