CH 19 professional issues part A Flashcards
Nurse Practice Act
rules in each state for nurses
-qualifcations for licensure
-nursing titles (NP) that are allowed to be used
-scope of practice (vary state to state! if practice state A and have full practice authority don’t need doc collab. if move to state B, can u practice like state A? need to check state B practice act to know what to do in that state
If i have full practice authority (don’t need doc collab) & I move to state B, can u practice like state A?
need to check state B practice act to know what to do in that state
have 54 different practice acts to fully autonomous to highly restrictive
process of credentialing
-confirms HCP meets regulations in the state where practice is located
-investigates NP’s background is well investigated
-provides practice authority in given healthcare setting
-enables insurance reimbursements
-defines clinical, hospital privileges
NP credentialing process
education
certification
licensure
criminal backvround check (CORI, SORI)
work hx, employment background
natioanl practitioner data bank (malpractice or other actions against NP)
status of clinical or hospital privileges a/s with former employment
DEA number
needed to prescribe controlled substances
schedule 1-5 substances ranked
DEA number
needed to prescribe controlled substances
schedule 1-5 substances ranked
schedule 1 controlled substances
ILLEGAL
no one has this license
herone, MDMA, PCP
schedule 2 controlled substances
legal to prescribe BUT significant abuse potential
morphine, fentanyl, methadone, oxycodone, methylpenidate, anabolic steroids
schedule 3 controlled substances
less abuse potential
teststerone, butalbital (Fioricet) etc
schedule 4 controlled substances
low abuse potential
common sleeping aids (zolpidem (Ambien), short acting benzos, phentermine
schedule 5controlled substances
low abuse relative to schedule 4
few meds like antidiarrheals diphenoxylate/atropine (Lomotil)
beneficence
PCP obligation to help people in need
nonmaleficence
do no harm with or w/o intention
if harm is unavoidable, must minimize harm
autonomy
right of competent person to choose a personal plan of life, action by exercising rights of self determination, independence and freedom
-put my opinions away and provide unbiased info risks and benefits of tx
-i respect pt’s well informed decision
goals of autonomy
-avoid paternalism such as forcing my choice to the pt when given 2 options
autonomy is not an absolute right because
if it interferes with the rights and wellbeing of others
ie: someone has TB in the hospital and refuses to get tx for it. they can be sued and forced to get tx bc they can expose the nurse
if impaired cognitive impaired person, decision making can be deferred to
health care proxy
need sig impairment
competency
ability to exercise rights to give or refuse informed consent
justice
utilitarianism
utility = working well for the most good
-ie: vaccines to avoid illness
veracity
HONEST!
B! fair and unbiased manner
denying antibiotics!!!!!
if give antib, and gets complication like c diff and adverse effects and didn’t need it, can get sued
A. beneficence = helping ppl in need
veracity - to tell the truth
autonomy
informed consent pt side
disclosing info to competent pt who can voluntary choice
-DISCUSS DIRECTLY TO THE PT WHAT HAPPENS IF NO TX HAPPENS
informed consent PCP side
is consent ever presumed?
components of competency
i provide info and make sure pt understands or they can sue
who can declare if someone is competent or not?
only court can but if family, HC proxy agree pt cannot make informed decision
NO
pt needs dialysis but reports wrong date, time, president.
she demonstrates competency and wishes should be followed. and said ‘i guess ill die’ she understands its a machine and is old.
advanced directives
durable statements of intent based on pts wishes
-living will is 1 type
5 wishes document
a willl that meets requiremnts of AD
-WHO makes decisions when unable
-how pt wants ppl to tx person and what they want love ones to know
healthcare proxy/agent
healthcare surrogate or attorney
-18 years and older
-speaks FOR pt if anesthesia or unable to voice
-usu spouses is “de facto” proxy if none other
daughter of 88 man calls about me. shes asking about his meds.. do u tell her?
assume compentency unless mentioned otherwise!
tell her no she can only speak to pt
culture
culture sensitivity
culture knowledge
culture competence
if mentions a “Croation” or ethnicity, just cross it out and answer the q with any culture competence answer
ask the pt’s father if he has any q’s with son’s are
common in asian cultures
head nodding means he understands
- only go to his son ONLY if he’s not competent and thats his proxy
Mal de Ojo
Evil eye
folk belief in hex (mediter, latino,muslin, etc)
- stronger or powerful person (adult) gazes at a weaker person
-gaze can be inadvertent ( no ill intent) or intentional
the malignant gazer could be
jelaously coveting the baby (curse)
amulet protects
the gazer could be admiring a lovely baby
ask permission to look at the baby
then offer congrats and god bless baby and her, in most cultures removes hex on the baby. the mom counteract and say it’s not that beautiful
illnesses as a result of evil eye
usu in younger kids
- headache
fever
diarrhea
distuebed sleep
incr fussiness
protection from evil eye
diffs culture to culture
tx for evil eye
tradtional healer
-support with healthcare
-using raw egg to rub child
say you are concerned he will get sick if ppl look at him?
-pose as question to info gathering bc ppl LOOK at him. directing back to ask for more info
malpractice
failure of PCP to exercise care as reasonable prudent PCP under the same or similar circumstances
what would your peers do under same situation?
compontents of malpractice
duty: relationship b/t me and pt
breach of duty: I violate standards when rendering care
if i refill a rx for a neighbor she is now my pt T/F
true
proximate cause
plaintiff establishes a relationship b/t breach and the injuries
make sure to educate about medication and side effects
explain WHY ur going on this antibiotic and likely will recover in a few days. the neg are diarrhea, candida, vaginitis. i can give u a cream u can buy OTC to help so they are WELL INFORMED. most women don’t need to but just be aware
2 types of liability insurance policies
- occurance basis
- claims made
occurance basis policy
i get sued 3 years from now but my policy was in place during that time
claims made policy
I have this in place 2 yrs ago but stopped practice 1 yr ago. this year, someone sue me based on an encounter 2 years ago. I’m covered for this claim since it carries a “tail” policy
A
Medicare
fed sponsored insurance for:
-65 and older
-under 65 with disabilities
-End stage renal dz (dialysis or transplant)
medicare part A
medicare part B
NP skill level, not RN lvl to be reimbursed
medicare Advantage (Part C)
medicare part D
“incident to” is a billing MEDICARE term that allows
100% reimbursement at MD rate
“incident to” rules
if we are more independent/np only practice, we get reimbursed 85% but if we practice with a MD, we get 100%
-we get paid more when practicing independently
medicaid
-low income
medicaird requirements
-US national, citizen, permanent resident
-low or v low income
-blind, dissabled, elder, pregnant, children with disability or resp of kids if under 19 yrs old
true for all.
true
false
HIPPA purpose
who is a covered entity?
HC providers who electronically transmit health info in connection with a standard transaction
