Intro to Professional Nursing Exam 3 Questions and answers

Intro to Professional Nursing Exam 3 Questions and answers Common law is decisional, meaning that judges' rulings become law Statutory Law are those established through formal legislative processes Administrative Law result when the legislative branch of government agencies to create laws that meet the intent of a statute Civil Law recognizes and enforces the rights of individuals in disputes over legal rights or duties of individuals in relation to one another Criminal Law Involves public concerns regarding an individual's unlawful behavior that threatens society, such as murder, robbery, kidnapping, or domestic violence Nurse Practice Act: Who is it established by? Does it vary? It's established by the state legislator May vary somewhat from state to state 4 Objectives of Nurse Practice Act 1. It defines the practice of nursing in that state (defines what nurses can and can't do) 2. Sets minimal qualification to be a nurse 3. Determines legal titles and what abbreviations they can have behind theirname 4. Provides disciplinary action If you belong to ANA then you can... *If you belong to ANA then you can lobby and write to state legislators, so they can have a say in what they can and can't do Nurse Practice Act: Development guided by Nsg Org. ANA - Model Practice Act NCSBN Model Practice Act Nurse Practice Act: State Legislative Branch delegates authority to enforce the law to an Executive Agency - usually the Board of Nursing State Board of Nursing Mirrors state/national government 1. Executive: Administers Nurse Practice Act 2. Legislative: Creates rules to carry out Nurse Practice Act 3. Judicial: enforces the Nurse Practice Act Who are the members appointed by? Governor State Board of Nursing: Judicial has the authority too.... (2) 1. discipline- most common reason - practicing while impaired 2. Deny licensure Most common reason nurses get in trouble? -Practicing as a nurse while impaired and another common one is continuing education Purpose of Licensure? protect the public Licensure: Mandatory License to practice as nurse - Required Licensure: Permissive Someone can practice the profession/occupation of nurse as long as they don't use the title - Licensure: Mandatory Licensure -required for LPN and RN in all states - can call themselves nurses. -CNA's and UAP - can't call themselves nurses NCLEX -Tests critical thinking and nursing competence -Must complete basic nursing education at state-approved school of nursing Mobility of Licensure 1. Endorsement 2. Compact Legal Risks: Malpractice is is negligence applied to the acts of a professional Legal Risks: Negligence is is the failure to act as a reasonably prudent person would have acted in the same circumstances Legal Risks: Malpractice may occur in 2 ways 1. commission: doing something that should have not have been done 2. Omission: failing to do things that should have been done Legal Risks: Conditions of Malpractice 1. Has the duty to care for that patient 2. You breached that duty of care by failing to meet the standard of care 3. Failure to meet the standard of care was the proximate cause of the injury 4. The injury is proved Legal Risks: Categories of Negligence Malpractice (6) 1. failure to follow standards of care 2. Failure to use equipment in a responsible manner 3. Failure to communicate 4. Failure to document 5. Failure to assess and monitor 6. Failure to act as a patient advocate Legal Risks: 5 Rights of Delegation 1. Right Task 2. Right circumstances 3. Right person 4. Right direction/communication 5. Right supervision/evaluation Legal Risks: Assault the attempt to make bodily harm Legal Terms: Battery actually causes harm Legal Risks: Informed Consent -Voluntary -Competent (have to have a guardian for a child) -Informed Decision (must be fully informed) Do you have to have a cosigner for making sure a pt understands the pros and cons to a procedure? Yes; all your signature means is that they seem informed and you didn't provide the teaching about the procedure Legal Risks: Confidentiality HIPAA Legal Risks: Confidentiality: Social Media-6 myths 1. Posts and ph0tos are private and accessible only to the intended recipient 2. once content has been deleted, it is no longer accessible 3. No harm is done if patient information is disclosed only to the intended recipient 4. It is acceptable to refer to a patient by a nickname, room number, or diagnosis/condition 5. If your patient is posting about his or her health condition, you may also post about it 6. Social media blurs the distinction between one's professional and personal lives Legal Risks: How can Nurse Protect Him/Herself? 1. Practice in Safe Setting 2. Communicate 3. Delegate wisely 4. Meet/exceed Standard of Care 5. Professional Liability Insurance 6. Positive Interpersonal Relationships ETHICAL DIMENSIONS OF NURSING Morals provide standards of behavior that guide the actions of an individual or social group and are established rules of conduct to be used in situations where a decision about right and wrong must be made Values are attitudes, ideals, or beliefs that an individual or a group holds and sues to guide behavior Ethics a term used to reflect what actions an individual should take and may be "codified" as in the ethical code of a profession. -are process oriented and involve critical analysis of actions Bioethics is the application of ethical theories and principles to moral issues or problems in health care Deontology -Act is moral if it originates from good will -Rule - "do no harm" -Duty - "patient allowed to make own decision Utilitarianism -Moral rightness of action -Greatest good for greatest number of people Virtue Ethics -Choose the right thing to do based on virtues -b/c they have a natural tendency to act the right way Code of Ethics: is it a legal document? No; It's a guideline for professional conduct Code of Ethics: -Hallmark of a mature profession -Social contract a. Guide to practice, what the nurse should do b. Inform society of principles and rules that guide nursing-not a "how to" guide -Guideline for professional conduct Code of Ethics for Nurses with Interpretive Statements (2001): Developed by who? Developed/revised by ANA Ethical Principles? (7) Respect Autonomy Beneficence Nonmaleficence Veracity Fidelity Justice Respect? All patients have Autonomy? Have the right to make their own choices, refuse care Beneficence? -"the doing of good" -Health care providers are challenged daily when what is good for the patient may also cause harm to the patient or is in conflict with what the patient wants Nonmaleficence? -Are we causing more harm than good? -Is defined as the duty to do no harm Veracity? We should always tell the truth Fidelity Refers to the faithfulness or honoring one's commitments or promises Justice -Is that equals should be treated the same and that unequals should be treated differently -Fair and equitable treatment Ethical Decision Making w/ Nurses Nurses must make a judgement or decision when 2 or more values are incongruent Ethical Decision Making: Model (6) Clarify what the dilemma is Gather information Identify options Make a decision Act Evaluate Ethical Dilemmas in Nursing? (7) 1. Personal Value Systems 2. Peers' and Other Professionals' Behavior 3. Patients' Rights 4. Patient Self Determination Act, p.145 5. Immigration and Migration 6. Institutional and Social Issues 7. Patient Data Access Issues Patient Self-Determination Act -is a safeguard for patients' rights, giving patients the legal right to determine how vigorously they wish to be treated in life-or-death situations, and calls for hospitals to abide by patients' advance directives. -This act encourages individuals to think about the type of medical and nursing treatment they would want if they were to become critically injured or ill. Ethicals Issues r/t immigration and migration? (2) 1. communication/language problems b/n patients and health care providers 2. The migration of nurses Health Care Delivery System: US Health Care Delivery System Illness Model? We take care of people after they are sick Health Care Trends? (11) 1. Increase in older population (3rd party payers, federal/state payers, out of pocket) 2. Increase in technology 3. Economic globalization 4. Changing payment structures 5. Population health 6. Reducing cost of care delivery 7. Becoming a health plan/company 8. outpatient shift 9. Personalized medicine 10. Partnerships 11. Consumerism 4 Categories of Service 1. HEALTH PROMOTION 2. ILLNESS PREVENTION 3. DIAGNOSIS AND TREATMENT 4. REHAB AND LONG TERM CARE 4 Categories of Service: Health Promotion Assist patients to remain health, prevent diseases and injuries, detect diseases early, and promote healthier lifestyles 4 Categories of Service: Illness Prevention -Services are now better able to assist patients in reducing the impact of those risk factors on their health and well-being -These services require the patient's active participation 4 Categories of Service: Diagnosis and Treatment In US heavy emphasis 4 Categories of Service: Rehab and Long-term care Help restore the patient to the fullest possible level of function and independence after injury or illness 4 classifications of agencies 1. PUBLIC/GOVERNMENT 2. VOLUNTARY/PRIVATE 3. FOR PROFIT 4. NOT FOR PROFIT 4 classifications of agencies: Public/Government -Contribute to the health and well-being of US citizens -Funded by taxes a. FEDERAL: Medicare -They promote and duct health and illness research, provide funding to train health care workers, and assist communities in planning health care services b. STATE: Medicaid -Oversea programs that affect the health of citizens within an individual state -Federal and state 4 classifications of agencies: Voluntary/Private -Support is generally through private donations -Often begin when a group of individuals bands together to address a health problem 4 classifications of agencies: For Profit -Board of directors that pay taxes and get dividends based on the revenue -Distribute profits earned to partners or shareholders 4 classifications of agencies: Not for profit -Reinvest revenue back into organization Classification: 4 Levels of service 1. PRIMARY 2. SECONDARY 3. TERTIARY 4. SUBACUTE/SKILLED 4 Levels of service: Primary -Care rendered at the point at which a patient first enters the health care system -Student health clinics community health centers, emergency departments, physicians' offices, nurse practitioners' clinics, or health clinics at worksites 4 Levels of service: Secondary -Involves the management of a condition or illness by a specialist -Prevents complications from disease -Ex: surgery centers, 4 Levels of service: Tertiary -Provided to acutely ill patients, to those requiring long term care, to those needing rehabilitation services, and to terminally ill patients -Ex: Mayo clinic, UofI hospital, trauma centers, burn centers, and pediatric hospitals 4 Levels of service: Subacute/Skilled -Generally more intensive than skilled nursing facility care and less intensive than acute inpatient care -Acute b/n long term care -Multidisciplinary approach -Efficient type of care Hospitals Today: 1. _______ Number of hospital days 2. ______ (more or less) acutely ill patients 3. _______ (old/young) patients 4. _______ (more/less) chronic illness 5. ________(low or high) Technology 1. decrease 2. more 3. older 4. more 5. high Health Costs: (8) 1. Inflation (Has increased 20% more than GNP) 2. Technology (new tech=more training=more costs) 3. Research needed for new medications 4. litigation (law suits) 5. Insensitivity of consumer 6. Population: Elderly 7. Increased Demand 8. Working uninsured (affordable care act tried to prevent) Financing health care: goal? Provide quality health care while lowering cost In 2010: _ _% OF GNP WAS SPENT ON HEALTH CARE, 16% Economic Theory: Law of Supply and Demand SUPPLY: if supply exceeds demand then sale DEMAND: demands exceeds supply then price increases Principles of Free Market Applied to Health Care: 1. Consumers (do or do not) always shop for health care 2. Can't always control _______ or _______ 3. Health care needs can be _______ 4. Price __________ 5. Health care providers (not always or never) motivated to be cost effective 1. do not 2. demand or illness 3. immediate 4. insensitivity 5. not always motivated to be cost effective Health Care: A right or Priviledge? 1. Right? 2. Priviledge? 1. Health is a right because the overall public's health would improve and economic productivity would improve 2. If you look at it as a business -Pure free market economy -Providing health care to everyone would increase wait times for health care services History of HC finance? 1. Before WWII 2. After WWII 3. Hill Burton Act? 1. all out of pocket 2. insurance companies started to become a thing 3. Funding for hospitals Retrospective Payment: 1. What is it? 2. Hospital was paid after _____ and ____? 3. Result: (4) 1. PAYMENT AFTER CARE IS GIVEN 2. HOSPITAL WAS PAID AFTER DEDUCTIBLES AND COPAYS 3. RESULT: PATIENT DID NOT ASK QUESTIONS NOT CONCERNED ABOUT COST INCREASE IN DEMAND INCREASE IN COSTS Attempts to control costs: 1. 1980s 2. Based on paying 3. Prospective payment system: sets limit on? 1. government attempt to control costs 2. based on paying before the services are given 3. Set limits on amount of money paid for services Control Costs: Prospective payment (3) 1. MEDICARE USES 2. DIAGNOSTIC RELATED GROUPINGS (DRG'S) -Is the primary form of prospective payment systems 3. DRG'S FALL UNDER THE INPATIENT PROSPECTIVE PAYMENT SYSTEM Medicare: Linking quality to payment (3) 1. HOSPITAL READMISSION REDUCTION PROGRAM -Medicare is paying hospitals based on readmissions 2. HOSPITAL QUALTIY OF CARE 3. HOSPITAL-ACQUIRED CONDITION REDUCTION PROGRAM Other attempts to control costs? (4 types of care) 1. managed care 2. home health care 3. certificate of need 4. professional review organizations Methods of health care payment: Medicare? 1. State? Federal? 2. For who? 3. Funding? 4. What kind of payment? 5. How many parts? 1. Federal 2. Over age of 65 and some disabled 3. taxpayers 4. individual payments 5. A, B, C, D