Leadership and Management for Nurses 3rd Edition Finkelman Instructors Manual

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Leadership and Management for Nurses 3rd Edition Finkelman Instructors Manual

ISBN-13: 978-0134056982

ISBN-10: 0134056981




Leadership and Management for Nurses 3rd Edition Finkelman Instructors Manual

ISBN-13: 978-0134056982

ISBN-10: 0134056981





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Chapter 11: Consumers and Nurses





Examine the history of healthcare consumerism and its impact on health care.


Suggestions and Strategies for Classroom Experience

  • Ask students to search the Internet for sites that focus on healthcare consumers and to describe the content and issues discussed on the site.


Suggestions and Strategies for Clinical Experience

  • Considering the aspects of consumers noted in first slide for this Outcome, how do students view these issues in their clinical sites? What are the concerns with these issues? Is improvement needed? (Aspects to consider are: Informed advocacy, patient satisfaction and utilization of health care services, quality, cost, and access.)




Assess the relationship between public policy and the healthcare consumer.


Suggestions and Strategies for Classroom Experience

  • Ask a few representatives from local consumer health organizations such as the Arthritis Association or American Diabetes Association to come to class for a panel discussion about their role as advocates and some of the common concerns that they share.


Suggestions and Strategies for Clinical Experience

  • Ask students how the Patient Self-Determination Act of 1990 applies to clinical practice in the settings where they have been assigned for clinical.




Compare and contrast the consumer implications of the Healthy People and the Institute of Medicine reports (Quality Chasm series).


Suggestions and Strategies for Classroom Experience

  • Review the Healthy People website from perspective of consumerism. Ask students to discuss how consumerism applies to Healthy People.


Suggestions and Strategies for Clinical Experience

  • Explain how the IOM reports focus on the consumer. Provide examples. How might you emphasize the role of the consumer more in your practice?




Assess the importance of the role of technology in consumer healthcare information.


Suggestions and Strategies for Classroom Experience

  • Ask students how their family members and friends obtain health information as consumers, and how they use it.


Suggestions and Strategies for Clinical Experience

  • Ask students if patients and families mention technology as source of information.




Examine the relationship between patient education and healthcare consumerism.


Suggestions and Strategies for Classroom Experience

  • Ask students to explore how consumer education about self-managing care, use of primary care providers and specialists, and medications has been supported in their community (e.g., advertising, educational programs, activities and information provided by healthcare organizations).


Suggestions and Strategies for Clinical Experience

  • Explore what hospitals that students have used for clinical experiences have done to assist consumers with hospitalization decisions. Students could also ask their patients and patients’ families about how they made their hospital decisions.




Critique how consumers are involved in evaluating the quality of care.


Suggestions and Strategies for Classroom Experience

  • Conduct a student debate on the value of patient satisfaction data. After the debate concludes, the class should vote on the best presentation or the side they support.
  • A representative from an insurer and/or a local hospital can come to class to discuss how the organization collects patient satisfaction information and what is done with the data.


Suggestions and Strategies for Clinical Experience

  • Discuss with students what patient evaluation activities are conducted by clinical sites. What data are collected? How? What are the results? What is done with the data?




Apply patient advocacy to the role of the nurse manager.


Suggestions and Strategies for Classroom Experience

  • Explore what nurses have done, locally and statewide, to support consumerism.
  • Nurses who have been involved in these activities could present to the class.
  • Students could work in teams, each taking a different consumer issue, such as cost, access, and prescription reimbursement, and present an advocacy program on the issue.


Suggestions and Strategies for Clinical Experience

  • Students interview nurses and ask them how they view themselves as patient advocates.
  • Students can be asked to discuss examples of when they have been patient advocates.




  1. Healthcare consumerism has evolved over the years, with consumers growing in their informed advocacy. In the 1970s, consumers were informed and assertive about their active participation in health care. In the 1980s, the focus changed to the cost of health care. Consumers were not as active in the early 1990s but became more active at the end of the decade.
  2. As consumers experience problems with health care, they often criticize health care, and have demanded changes in managed care and other aspects of reimbursement and care delivery. With the development of managed care, consumerism became even more important, and we saw even more involvement during the development of healthcare reform of 2010.
  3. Managed care has had an impact on consumerism since consumers became concerned about how managed care was taking away their choices for care and providers. There are, however, positive changes that have occurred due to managed care, such as increased emphasis on preventive care, health promotion, and continuity of care. There is no doubt that managed care organizations are listening more to their members and enrollees.
  4. Healthcare policy makers need to listen to consumer needs and understand consumer responses to healthcare proposals and services. By doing this, they can make policy more responsive to reality.
  5. Consumers also have a role in public policy through advocacy—speaking out about what they need and their evaluation of care or services that are provided or need to be provided.
  6. Consumer rights have become a major issue in healthcare policy due to dissatisfaction with managed care. The Patient Self-Determination Act of 1990 requires that healthcare organizations that receive Medicare and Medicaid funds give patients information about their rights. There also have been initiatives to establish a patient’s bill of rights at the federal level, but this has not occurred yet.
  7. Although probably initiated by dissatisfaction with managed care, many of the consumer driven changes had little to do directly with managed care and really focused more on health care in general, leading to demands for more patient-centered healthcare policies.
  8. The consumer rights issue is very controversial. If too many consumer rights are recognized, how will this affect the ability of insurers to meet their goals to reduce healthcare costs?
  9. Healthy People 2020 is a national preventive initiative that identifies opportunities to improve the health of all Americans by identifying goals and objectives to promote health with disease and illness prevention. Consumers need to be involved in this initiative, as self-management is critical to its success. There are two major goals: increase quality and years of healthy life, which focuses on life expectancy, and quality of life; eliminate health disparities, which focuses on a variety of factors that affect health disparities such as gender, race, ethnicity, income, and education.
  10. Healthy People 2020 program is in the development stage and will be implemented over the next 10 years as has been done with the other Healthy People initiatives. It is based on work done with Healthy People 2010 and its outcomes.
  11. One of Healthy People’s major overall goals is to improve the quality of health-related decisions through effective communication. Objectives include the need for consumer education, advocacy, and self-management of illness, all of which are supported by the IOM quality reports.
  12. The IOM strongly recommends need for patient-centered care, collaboration, care coordination, and advocacy. Patients as consumers need to play an active role in their treatment and are members of the interdisciplinary team. Includes two dimensions, one of which is “consumer perspectives of healthcare needs”—including achieving health, staying healthy, living with illness or disability, and coping with the end of life. Families and caregivers need to be involved in each of these elements of the consumer dimension. This quality improvement matrix draws the patient directly into the quality improvement process.
  13. The National Healthcare Quality Report provides consumers with information about healthcare quality.
  14. Technology has revolutionized the amount and quality of information available to healthcare consumers. Interactive technology has changed the availability of information, particularly electronic mail, websites, intranets, interactive voice response systems, mobile phones, and smartphones. The Internet is the front-runner of these sources. Consumers are turning to these sources for guidance and to educate themselves better about health care.
  15. Technology opens up new roles for the nurse in healthcare organizations. Nurses may play an active role in the development and maintenance of these sites for providers and for insurers who want to make them available to members. Content needs to be accurate and useful, and nurses have the clinical expertise and ability to develop this content for consumers.
  16. Information and education play vital roles in promoting health; preventing, managing, and coping with disease; and supporting decisions across the spectrum of health care. Effective health communication can help raise awareness of health risks, provide motivation and skills to reduce them, bring helpful connections to others in similar situations, and offer information about difficult choices.
  17. Consumers who are educated about healthcare delivery and their own healthcare needs are more effective consumers. Key areas of focus are self-managing care, use of primary care providers and specialists, medications, and hospitalization. Insurers/managed care organizations compete for coverage through employers and then to get employees to enroll in their plans. As a result, there is more interest in patient satisfaction and consumer interest in quality of care. Information about quality of care is largely gathered through surveys. Sometimes data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is also used to assess quality of care.
  18. Consumer education about self-management, primary care, medications, and hospitalization are important.
  19. The most important quality indicators for health care include getting achieving health, getting care and services when needed, having diagnoses and treatment options, being treated with respect, not being rushed, and communicating with nurses.
  20. It is important not to assume that positive patient satisfaction means that the care delivered is of high quality. Some patients might be satisfied about some aspects of care that might not be relevant when determining the quality of care. Nurses must avoid assuming that if healthcare professionals have positive views of quality of care and patient satisfaction that the patient will agree. Consumers and providers might differ on the relevant indicators of quality.
  21. Advocacy is a major aspect of the nursing role with the consumer. The ANA and AONE nursing administration standards expand on advocacy and discuss the nurse administrator role in advocating for staff and for a healthy work environment (see Box 10-2). Advocacy includes two important components: providing information that is useful to the patient and supporting the patient’s decision. To be successful, collaboration must be part of the process between nurse and patient.



BSN and Master’s Essentials: Application to Content

Chapter identifies which Essentials apply to the chapter content. This information is primarily for the instructor, but students should understand how these nursing education standards apply to the chapter content and the nursing profession.

My Hospital Unit: An Evolving Case Experience

See the overview of the My Hospital Unit feature found in the front of the . Refer students to the specific My Hospital Unit scenario found in the chapter.

This chapter feature can be used in a variety of ways within a course. Students can be asked to complete per chapter and submit in writing or use in team discussions in the classroom or online. This is an evolving case that provides students with the opportunity to apply content and be creative in how they accomplish this. Students should maintain a record of their work per chapter and build on previous responses from one chapter of My Hospital Unit experience to the next.

Applying AONE Competencies

The AONE competencies for nurse leaders are found in Appendix A. Ask students to identify which of the AONE competencies apply to the content in the chapter.

Engaging in the Content: Critical Thinking and Clinical Reasoning and Judgment

See Discussion Questions and Application Exercises at the end of the chapter. Online options are noted.

Chapter Features: Case Study and Applying Evidence-Based Practice

The Chapter Features: Case Study and Applying Evidence-Based Practice features may be used in both classroom and online formats. The last two slides in the PPT slides include the questions related to each of these chapter features. They may be integrated into the lecture or deleted. Students should be asked to review the case and the EBP feature information in order to respond to the questions. This may be done as individual student written activity, team discussion in the classroom, team discussion in an online course, or as classroom discussion. Students should be encouraged to obtain the reference for the EBP feature to fully complete the learning activity.




This case is not found in the . It may be used for individual or team assignments: written assignment and classroom or online team discussions. It may also be used as an essay question for exams.


The case study for Chapter 10 describes how a county health department is assessing its current needs. Review that case study, but now we will focus on consumers.


  1. Who are the consumers in the community?
  2. Who in the community should be included in assessment of need? How might this be done?
  3. Who should be included in plans to address needs? How might this be done?


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