Issues, trends, and Health Policy Part IV/ Professional Responsibility Flashcards
Scope of Practice
1. Based on legal allowances in each _____, according to and delineated by individual State Nurse Practice Acts
State
Scope of Practice
3. Key elements of the NP role include the integration of care across the acute illness continuum with collaboration and coordination of care, research-based clinical practice, clinical leadership, family assessment, and _______ planning.
discharge
Scope of Practice
2. Provides guidelines for nursing practice; varies from _____ to _____
state to state
Standards of Advanced Practice
Both generic and specific specialty standards _____.
exist
Standards of Advanced Practice
Delineated by the American Nurses Association (1996)
as ______ statements by which to measure of
practice, service, or education
authoritative
State Practice Acts
States also vary in specific practice requirements, such
as _______
certification
State Practice Acts
Authorize Boards of Nursing in each state to _____
statutory authority for licensure of registered nurses
establish
State Practice Acts
Authority includes use of title, ________ for scope
of practice including prescriptive authority, and
disciplinary grounds
authorization
Prescriptive Authority
While the Drug Enforcement Agency (DEA) has ruled
that nurses in advanced practice may _____
registration numbers, state practice acts dictate the
level of prescriptive authority allowed.
obtain
Prescriptive Authority
The ability and extent of the NP’s ability to prescribe
medications to patients is dependent on ___ nurse
practice acts.
state
Credentials
Encompass required education, licensure and
________ to practice as a nurse practitioner
certification
Credentials
Establish minimal _____ of acceptable performance
levels
- Credentialing is necessary to:
a. Ensure that ____ health care is provided by
qualified individuals
safe
- Credentialing is necessary to:
b. ____ with federal and state laws relating to
advanced practice nursing
Comply
Credentials
4. Acknowledges the ____ of practice of the NP
scope
Credentials
5. Mandates ________
accountability
Credentials
6. Enforces professional standards for ______
practice
_________
Establishes that a person is qualified to perform in a
particular professional role
Licensure
Licensure
Licensure is granted as defined by rules and
regulations set forth by a governmental regulatory
_____ (i.e., state.board of nursing)
body
Certification
2. Certification is granted by nongovernmental agencies
such as the _____, AANP, PNCB, NCC.
ANCC
Certification
1. Establishes that a person has met certain standards in a particular profession which signify ____ of specialized knowledge and skills
mastery
Admitting Privileges to Hospitals
1. Non-physician providers were granted the possibility of hospital staff membership in ____ by the Joint Commission.
1983
_____ and _______
1. Process by which a nurse practitioner is granted permission to practice in an inpatient setting
Credentialing and Privileging
Credentialing and Privileging
2. Credentialing with hospital privileges is granted by a Hospital ____ _____ comprised of physicians who hold privileges at the given hospital where the NP has made request
Credentialing Committee
Credentialing and Privileging
3. Privileges may be granted in ____ or full; stipulations regarding the allowance of future privileges may be made by the Credentialing Committee (e.g., number of additional supervised hours required before a certain privilege is granted)
part
____ _____ _____
1. Results when the caregiver-patient relationship is terminated without making reasonable arrangements with an appropriate person so that care by others can be continued
Patient Medical Abandonment
Patient Medical Abandonment
2. Determination of patient abandonment may depend on many factors including:
a. Whether the practitioner _____the patient
assignment (which formally created a practitioner-
patient relationship)
accepted
Patient Medical Abandonment
2. Determination of patient abandonment may depend on many factors including:
b. Whether the practitioner provided _______
notice before terminating the practitioner-patient
relationship
reasonable
Patient Medical Abandonment
2. Determination of patient abandonment may depend on many factors including:
c. Whether reasonable ________ could have
been made to continue patient care when the
adequate notification was given
arrangements
Patient Medical Abandonment
3. In most cases, the following do not constitute patient abandonment:
a. An NP refuses to _____ responsibility for a patient
assignment when the NP has given reasonable
notice to the proper authority that the NP lacks
competence to carry out the assignment
accept
Patient Medical Abandonment
3. In most cases, the following do not constitute patient abandonment:
b. An NP refuses an assignment of a _____ shift or
additional hours beyond the posted work schedule
when proper notification has been given
i) When “proper notification has been given”
potentially becomes a problematic and
sometimes, arguable phrase in difference of
opinion.
double
Risk Management
- A systematic effort to reduce risk begins with a formal, written risk management plan that includes:
a. The organization’s _______
goals
Risk Management
1. A systematic effort to reduce risk begins with a formal, written risk management plan that includes:
b. Delineation of the program’s ______, components
and methods
scope
Risk Management
1. A systematic effort to reduce risk begins with a formal, written risk management plan that includes:
c. Delegating _______- for implementation and
enforcement
responsibility
Risk Management
- A systematic effort to reduce risk begins with a formal, written risk management plan that includes:
d. Demonstrating ______ by the board
commitment
Risk Management
1. A systematic effort to reduce risk begins with a formal, written risk management plan that includes:
e. Articulates guarantees of _________ and
immunity from retaliation for those who report
sensitive information
confidentiality
Risk Management
2. ____ ____: The most common method of documentation
Incident reports
Risk Management
- Policies regarding incident reports should address:
a. Persons _______ to complete a report
authorized
Risk Management
- Policies regarding incident reports should address:
b. Persons ______ for review of a report
responsible
Risk Management:
- Policies regarding incident reports should address:
c. Immediate actions needed to minimize the _____ of the report’s event
effects
Risk Management:
- Policies regarding incident reports should address:
d. Persons responsible the _____-____
follow-up
Risk Management:
- Policies regarding incident reports should address:
e. A plan for ______ the aftermath of the report’s event
monitoring
Risk Management:
- Policies regarding incident reports should address:
f. Security and ______ of completed incident report forms
storage
- ____ ______: Important form for identifying problems before developing into actual incidents or claims; important to track and analyze just like incident reports
Satisfaction surveys
- Satisfaction surveys:
b. Employee and/or ______ satisfaction surveys
practitioner
- Satisfaction surveys:
a. ______ satisfaction surveys
Patient
- Complaints:
c. Persons responsible for monitoring ______resolution of the complaint
follow-up
- Complaints:
b. Persons responsible for ______ to the complaint
responding
- Complaints:
a. ______ notified after receiving a complaint
Persons
- ________: A key source of potential risk management information. A risk management plan should delineate tracking, analyzing and managing complaints by clearly identifying:
Complaints
- Action taking initiatives:
a. _______: Proactive risk awareness and safety programs in place
Prevention
- Action taking initiatives:
b. ________: Post-incident remediation to minimize the impact and prevent future occullences
Correction
- Action taking initiatives:
b. Correction: Post-incident remediation to minimize the impact and prevent future occullences
i) Corrective steps must be monitored and ______
audited
- Action taking initiatives:
c. ________: Essential for legal defense; thorough medical records and institutional policies
Documentation
- Action taking initiatives:
d. ________: M-services of all staff at orientation and annually, at a minimum
Education
- Action taking initiatives:
e. _____ ______: Encouraging departments and managers to work together for the common goal of improved patient and staff safety
Departmental coordination
Medical Futility
1. Refers to interventions that are unlikely to produce may significant benefit for the patient; “Does the intervention have any reasonable _____ of helping this patient?”
prospect
Medical Futility
2. Two kinds of medical futility are often distinguished:
a.____ _____: Where the likelihood that an
intervention will benefit the patient is extremely
poor, and
Quantitative futility
Medical Futility
2. Two kinds of medical futility are often distinguished:
b. _____ _____: Where the quality of benefit an
intervention will produce is extremely poor.
Qualitative futility
Informed Consent and Obtaining Informed Consent
1. ______ (Decisional Capability): A state in which a patient is able to make personal decisions about his/her care
a. Implies the ability to understand, reason,
differentiate good and bad and communicate
Competence
- Competence (Decisional Capability):
a. Implies the ability to _______, reason,
differentiate good and bad and communicate
understand
Informed Consent and Obtaining Informed Consent
2.___ _____: A state indicating that a patient has received adequate instruction or information regarding aspects of care to make a prudent, personal choice regarding such treatment
Informed Consent
- Informed Consent:
a. Includes discussing all of the benefits and ___ with a patient in order to make a truly informed decision
risks
- Informed Consent:
b. Generally, _____ is assumed if the patient’s condition is life-threatening
consent
- Right to ____ ____: Patients must be advised at the time of their admission to a federally funded institution such as a hospital, nursing home, hospice, HMO, etc. that they have a fight to refuse care (Danforth Amenchnent, 1991)
a. Care that may be refused includes any, some, or all,
as long as the patient has decisional capability
(competence)
Refuse Care
- Right to Refuse Care:
a. Care that may be refused includes any, some, or
___, as long as the patient has decisional capability
(competence)
all
_____: The study of moral conduct and behavior which serves to govern conduct, thereby protecting the rights of an individual
Ethics
__________: The duty to do no harm
Nonmaleficence
__________: The fight act is the one that produces the greatest good for the greatest number
Utilitarianism
______: The duty to be fair
Justice
________: The duty to prevent harm and promote good
Beneficence
_______: The duty to be faithful
Fidelity
________: The duty to be truthful
Veracity
_________: The duty to respect an individual’s thoughts and actions
Autonomy
Examples of reasons for ______ a patient from practice include: Abuse from the patient, refusal to pay for services, or patients’ persistent non-adherence to recommended care.
discharging
An NP cannot withdraw from caring for a patient without ________.
notification
- Steps for discharging a patient from a practice:
a. Send a certified _____ with rerun receipt requested;
copy for the chart
letter
- Steps for discharging a patient from a practice:
b. The content of letter should be general versus
specific.
i) The NP’s practice should have established
policies that all patients consent to in ____
such as recommended care, including
timeframes for canceling appointments or
rescheduling and payment of services.
writing
- Steps for discharging a patient from a practice:
b. The content of letter should be general versus
specific.
ii) These may serve as the foundation for the
_______ of healthcare.
termination
- Steps for discharging a patient from a practice:
c. Provide general healthcare coverage for the first 15-
30 ____ post-termination deadline
days
- Steps for discharging a patient from a practice:
d. Obtain release of _______ to provide copies of all
needed records for the subsequent care provider.
information
- Obligations in closing a practice due to relocation, retirement or other changes:
a. Give the patient adequate _____ to find another
provider
time
- Obligations in closing a practice due to relocation, retirement or other changes:
b. Keep all files for a minimum of ____ years. Follow
state laws regarding storage requirements.
five
- Obligations in closing a practice due to relocation, retirement or other changes:
c. To avoid complaints of patient abandonment,
provide timely notification and names of other
_______ and resources for future care
providers
- The role of the NP developed in the early 1960s as a
result of physician shortages in the area of ______.
pediatrics
- The first NP program was a pediatric NP program,
begun in 1964, by Dr. ___ ___ and Dr. Henry Silver
at the University of Colorado Health Sciences Center
Loretta Ford
- Growth of NP programs soon ensued with distribution
of NPs in various practice settings with an emphasis on
anabulatory and _____ care.
outpatient
- The historical service of NPs in primary care resulted in
part from the availability of federal funding for
_______ and primary care NP education.
preventative
- Movement of NPs expanded to the inpatient setting as
a result of managed care, hospital restructuring and
decreases in medical ______ programs.
residency
- Four distinct roles for the nurse practitioner include expert:
a. Clinician
c. Educator
b. Consultant/collaborator
d. _______
Researcher
Major Steps in the Research Process
- Formulating the research problem
- Reviewing related literature
- Formulating the ______
- Selecting the research design
- Identifying the population to be studied
- Specifying methods of data collection
- Designing the study
- Conducting the study
- Analyzing the data
- Interpreting the results
- Communicating the findings
hypotheses
___________: A “no experiment” design; usually includes taro broad categories of research, descriptive and ex post facto/correlational research
Nonexperimental
Nonexperimental:
a. ____ _____: Aims to describe situations, experiences, and phenomena as they exist
Descriptive research
Nonexperimental:
b. ___ ____ ____ or correlational research: Examines relationships among variables c.
Other possibilities
Ex post facto
____ _____: Study that examines a population with a very similar attribute (e.g., asthma)but differ in one specific variable (e.g., age); designed to find relationships between variables at a specific point in time; “surveys”
Cross sectional
_______: Research study that compares a particular outcome (such as lung cancer) in groups of individuals who are alike in many ways but differ by a certain characteristic (e.g., female nurses who smoke compared with those who do not smoke)
Cohort
__________: Study that involves taking multiple measures of a group/population over an extended period olftime to find relationships between variables
Longitudinal
____________: Includes experimental manipulation of variables utilizing randomization and a control group to test the effects of an intervention or experiment
Experimental
a. ___ _____ research involves manipulation of variables but lacks a comparison group or randomization.
Quasi-experimental
_________: Includes case studies, open-ended questions, field studies, participant observation and ethnoaphic studies, where observations and interview techniques are used to explore phenomena through detailed descriptions of people, events, situations, or observed behavior.
Qualitative
Qualitative:
a. Researcher _____ is a potential problem
bias
Qualitative:
b. _____ into question the generalizability of the findings
Calls
Qualitative:
c. Produces very _____ data through no other means of research
rich
- ______ _______: An interval, with limits at either end, with a specified probability of including the parameter being estimated
Confidence interval
- Confidence interval:
a. A small confidence interval implies a very ______
range of values
precise
- Confidence interval:
b. Example: Confidence interval = 2.8-3.2 –>
terminally ill bone cancer patients in the final
stage of illness have between 2.8 and 3.2
episodes of nausea every ____ hours
24
- ___ ______: Indicates the average amount of deviation of values from the mean
Standard deviation
- Standard deviation:
a. ____% of the sample falls within one SD of the
mean
68%
- Standard deviation:
b. ____% of the sample falls within two SDs of the
mean
95%
- ___ ___ ______: The probability level of which the results of statistical analyses are judged to indicate a statistically significant difference between groups
Level of significance
- Level of significance:
a. The probability of false _______ of the null hypothesis in a statistical test
rejection
- Level of significance:
b. Example: p < .05 –> the experimental and control groups are considered to be significantly ______
different
- _____ ______: A measure of the interdependence of two random variables that ranges in value from -1 to +1
Perfect correlation
- Perfect correlation:
a. -1 indicates a perfect ______ correlation
negative
- Perfect correlation:
b. 0 indicates an ______ of correlation
absence
- Perfect correlation:
c. +1 indicates a perfect ______ correlation
positive
5.___ ____: Statistical test to evaluate the differences in means between two groups
t-test
- ______ : The consistency of a measurement, or the degree to which an instrument measures the same way over time with the same subjects
Reliability
- Reliability:
a. Reflects the estimated _______ of a measurement
repeatability
- Reliability:
b. A measure is considered reliable if a person’s score on the same test given twice is ______
similar.
- Reliability:
c. Reliability is estimated in two ways:
a) ____/____: The more conservative method to
estimate reliability
i) One should get the same score on exam 1 as
one does on exam 2.
Test/retest
- Reliability:
c. Reliability is estimated in two ways:
b) _____ ________: Estimates reliability by
grouping questions in a questionnaire that
measure the same concept
i) Example: One could write two sets of three
questions that measure the same concept
(say knowledge of lipid panels) and after
collecting the responses, run a correlation
between those two groups of three questions
to determine if the instrument is reliably
measuring that concept
Internal consistency
- Reliability:
d. Cronbach’s ____ is a common way of computing correlation values among the questions on instruments. As with a correlation coefficient, the closer it is to one (optimal > .70), the higher the reliability estimate of the instrument.
alpha
- Reliability:
e. The major difference between test/retest and internal consistency estimates of reliability is that test/retest involves two administrations of the measurement instrument, whereas the internal consistency method involves only ______.
one
- ______: The degree to which a variable measures what it is intended to measure.
Validity
________
1. The legal responsibility that a nurse practitioner has for actions that fail to meet the standard of care, resulting in actual or potential harm to a patient
Liability
Liability
2. Standards of care are used as criteria to measure whether ______ has occurred.
negligence
________
1. Failure of an individual to do what a reasonable person would do, resulting in injury to the patient
Negligence
__________
1. Failure of a professional to render services with the degree of care, diligence, and precaution that another member of the same profession under similar circumstances would render to prevent injury to someone else
Malpractice
Malpractice
- May involve:
a. Professional ______
b. Unreasonable lack of skill
c. Illegal/immoral conduct
d. Other allegations resulting in harm to a patient
misconduct
- Malpractice insurance ____ ____ cover an advanced practice nurse (APN) from charges of practicing medicine without a license if the APN is practicing outside the legal scope of practicefor that State.
does not
______
1. An intentional act by one person that creates an apprehension in another of an imminent harmful or offensive contact
Assault
Assault
a. An assault is carried out by a _____ of bodily harm coupled with an apparent, present ability to cause the harm.
b. Examples: Shaking a fist in file air in the direction of another person, making the motion to inject someone against his will, etc.
threat
Assault
b. Examples: Shaking a ____ in file air in the direction of another person, making the motion to inject someone against his will, etc.
fist
_________:
1. An illegal, willful, angry, violent, or negligent striking of a person, his clothes, or anything with which he is in contact
Battery
- One can commit _______ on an unconscious person, but not assault.
battery
___________
1. A communication that causes someone to suffer a damaged reputation
Defamation
Defamation
a. _______: Defaming, distributed written material
Libel
Defamation
b. _______: Spoken defamation (spoken to other than the defamed party)
Slander
_____ ______
1. In most states, there is a duty to commit someone who is in danger of hurting himself or others as a result of mental illness (e.g., patients who attempt suicide).
Involuntary Commitment
Involuntary Commitment
2. A nurse practitioner is potentially liable if a patient is ________ while in danger of hurting himself or others.
discharged
Use of Restraints
1. It is legal to forcefully restrain someone to prevent a patient from ______ himself or others.
harming
Use of Restraints
2. The NP must document the exact _____/______ for why restraints are being ordered.
reason/rational
Use of Restraints
3. An NP may be liable if excessive restraints are employed, the _____ ____ for using restraints is not documented, or safety checks of the restraints are not charted.
exact reason
____ _____ _____
1. Protect health care providers from law suits who aid at the scene of an accident and render reasonable, emergency care, within the NP’s scope of practice.
Good Samaritan Statutes
________:
True positives; the degree to which those who have a disease screen/test positive
Sensitivity
_______:
True negatives; the degree to which those who do not have a disease screen/test
Specificity
______: The frequency with which a disease or disorder appears in a particular population or area at a given time; the rate in which new cases occur during a specific time period: Example: 20 cases of botulism per 500,000 people were reported in Alaska during 2010
Incidence
__________: The proportion of a population that is affected by a disease or disorder at a particular time; Example: the prevalence of lupus in women living in Illinois during 2010 was < 1%
Prevalence
___ ____: Includes rehabilitation and restoration of health
i) Examples: Cardiac rehabilitation following an MI,
physical therapy following an MVC, etc.
Tertiary Prevention
____ _____: Focuses on early identification and treatment of existing problems
i) Examples include: Pap’smear screening, prostate
cancer screening, cholesterol screening, etc.
Secondary Prevention
_____ _____: Includes measures to promote health prior to the onset of any recognizable problems
i) Examples: healthy diet, exercise, avoiding tobacco,
wearing seat belts, inanunizations/vaccinations,
safety initiatives, etc.
Primary Prevention
Culturally and Linguistically Appropriate Services (CLAS)
1. Ultimately, the aim of the standards is to contribute to the _____ of racial and ethnic health disparities and to improve the health of all Americans.
elimination
There are 14 CLAS standards. The following standards guide all providers, including NPs, in their direct care roles.
–> Standard ___: Healthcare organizations must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their fights to receive language assistance services.
6
There are 14 CLAS standards. The following standards guide all providers, including NPs, in their direct care roles.
–> Standard ___: Healthcare organizations must assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingnal staff. Family and friends should not be used to provide interpretation services (except upon request by the patient/consumer).
7
There are 14 CLAS standards. The following standards guide all providers, including NPs, in their direct care roles.
–> Standard ____: Healthcare organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.
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