Practice Issues; Ethical and Legal Principles Flashcards
Physician Orders for Life-Sustaining Treatment (POLST)
addresses vague language in a patient’s end of life care directives, such as “life support” and “no heroics”
Three phases of policy making
- Formulation
- input of information, ideas, and research from key people, organizations, and interest groups
- identification of the purpose and outcomes
- selection of strategies
- identification of needed resources - implementation
- dissemination of information about the adopted policy and putting it in place as a plan of action - Evaluation
- policies may be amended or rewritten to adjust for circumstances over time in an incremental manner
Physician-assisted suicide vs euthanasia
Physician-assisted suicide: making the means of death available to the patient
- legal in some states in the United States
Euthanasia: physician actually administers the method of death
- illegal throughout the United States
Orem’s theory of nursing practice
Focuses on professional and technological operations
1. The nurse diagnoses the patient and determines why nursing is needed
2. Designs the nursing system and plans for delivery of care
3. Production and management of nursing systems, labeled planning, and controlling
Nightingale’s theory of nursing
Based on creating a restorative environment
Abdellah’s theory of nursing
Based on the delivery of nursing care for the whole person, including the spiritual, physical, and emotional needs
Rogers’ concept of nursing
Focuses on the maintenance of health, prevention of illness, and the care and rehabilitation of disabled clients through the “humanistic” science of nursing
durable power of attorney
makes decisions not he patient’s behalf while the patient is still alive
Does not apply if the patient has died
advance directive
written statement of a patient’s intent regarding medical treatment
healthcare directive
type of advance directive that may (or may not) include a living will and/or specifications regarding durable power of attorney in one or two separate documents
living will
written compilation of statements that specifies which life-prolonging measures one does and does not want to be taken if he/she becomes incapacitated
durable power of attorney
A significant other is granted the ability to act as a proxy/agent/attorney-in-fact of the patient in making healthcare decisions should the patient become incapacitated.
Responsible for articulating the patient’s advance directive
strongest method to evaluate teaching
returned demonstration
Injuries that should be transferred to a tertiary facility
Major maxillofacial injuries
Severe Le Fort fractures:
- Le Fort 1: floating palate
- Le Fort 2: Floating maxilla
- Le Fort 3: floating face
most powerful data collected from a patient
subjective data
Health related information that must be reported to the Department of Health in most states
Criminal acts and injury from a dangerous weapon
Diseases: gonorrhea, chlamydia, syphilis, HIV, TB, COVID-19
Animal bites
Suspected or actual child or elder abuse
Level of physical exam documentation: A limited examination of the affected body area or organ system
problem focused
Level of physical exam documentation: A limited examination of the affected body area or organ system and any other symptomatic or related body area(s) or organ system(s)
expanded problem focused
Level of physical exam documentation: An extended examination of the affected body area(s) or organ system(s) and any other symptomatic or related body area(s) or organ system(s)
detailed
Level of physical exam documentation: A general multi-system examination, or complete examination of a single organ system and other symptomatic or related body area(s) or organ system(s)
comprehensive
Type of Medicare: Covers inpatient hospitalization, SNF services, home health services, and/or hospice associated with the inpatient event
Medicare A
Type of Medicare: Most people qualify to receive this benefit at 65 years of age
Medicare A
Type of Medicare: Covers physician services, outpatient hospital services, lab and diagnostic procedures, medical equipment, and some home health services
Medicare B
Type of Medicare: Supplemental medical insurance requiring recipients to pay a premium
Medicare B
Type of Medicare: NPs and CNSs receive 85% of physician reimbursement for services provided in collaboration with a physician
Medicare B
Type of Medicare: Medicare pays 80% of the patient’s bill for physician services and the patient pays 20%
Medicare B
Type of Medicare: Formerly known as “Medicare+Choice”, now known as “Medicare Advantage”
Medicare C
Type of Medicare: Patients entitled to Medicare A and enrolled in Part B are eligible to receive all of their health car services through one of the provider organizations under this Part (e.g. HMOs, PPOs, etc.)
Medicare C
Type of Medicare: Limited prescription drug coverage. Co-pay on each prescription is required
Medicare D
To qualify to be a Medicare provider, an NP must…
Hold a state license as an NP
Be certified as an NP by a recognized national certifying body
Hold at least an MSN degree
Sentinel event
Unexpected occurrences involving death or serious physical or psychological injury, or the risk thereof
Credential, Licensure, or Certification?: Encompasses required education, licensure, and certification to practice as an NP (e.g. degree, diploma)
credential
Credential, Licensure, or Certification?: Establishes minimal levels of acceptable performance
credential
Credential, Licensure, or Certification?: Necessary to ensure that safe health care is provided by quality individuals, and to comply with federal and state laws relating to advanced practice nursing
credential
Credential, Licensure, or Certification?: Acknowledges the scope of practice of the NP
credential
Credential, Licensure, or Certification?: Mandates accountability
credential
Credential, Licensure, or Certification?: Enforces professional standards for practice
credential
Credential, Licensure, or Certification?: Establishes that a person is qualified to perform in a particular professional role
licensure
Credential, Licensure, or Certification?: Granted as defined by rules and regulations set forth by a governmental regulatory body (I.e. state board of nursing)
licensure
Credential, Licensure, or Certification?: Establishes that a person has met certain standards in a particular profession which signify mastery of specialized knowledge and skills
certification
Credential, Licensure, or Certification?: Granted by nongovernmental agencies (e.g. AACN, ANCC)
certification
nonmaleficence
the duty to do no harm
utilitarianism
The right act is the one that produces the greatest good for the greatest number
beneficence
The duty to prevent harm and promote good
Justice
The duty to be fair
Fidelity
The duty to be faithful
Veracity
The duty to be truthful
Autonomy
The duty to respect an individual’s thoughts and actions
One standard deviation above or below the mean contains __% of the population being studied.
Two standard deviations above or below the mean contain __% of the population.
Three standard deviations above or below the mean contain __% of the population being studied.
- 68%
- 95%
- 99%
Type of research: A type of observational study that examines a population with a very similar attribute but differs in one specific variable (such as age)
cross sectional (non-experimental)
Type of research: analyzes a known outcome by looking back in time to assess exposure
case-control studies
Type of research: used to assess disease incidence and prevalence
cross sectional (non-experimental)
Type of research: Designed to find relationships between variables at a specific point in time or “surveys”
cross sectional (non-experimental)
Type of research: retrospective or prospective
cohort (non-experimental)
Type of research: 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 (non-experimental)
Type of research: A study that involves taking multiple measures of a group/population over an extended period of time to find relationships between variables
longitudinal
Type of research: A “no experiment” design; usually includes two broad categories of research, descriptive and ex post factor/correlational research
nonexperimental
Type of research: aims to describe situations, experiences, and phenomena as they exist
descriptive (non-experimental)
Type of research: Examines relationships among variables
ex post facto or correlational research (non-experimental)
Type of research: includes experimental manipulation of variables using randomization and a control group to test the effects of an intervention or experiment
experimental
Type of research: Involves manipulation of variables but lacks a comparison group or randomization
Quasi-experimental
Type of research: Includes case studies, open-ended questions, field studies, participant observation and ethnographic studies, where observations and interview techniques are used to explore phenomena through detailed descriptions of people, events, situations, or observed behavior
qualitative
Type of research: Researcher bias is a potential problem
qualitative
Type of research: Calls into question the generalizability of findings
qualitative
Type of research: Produces very rich data through no other means of research
qualitative
Type of research: Highest level of research
Meta-analysis of randomized controlled trials
Type of research: Lowest level of research
Editorial/expert opinion
Type of research: Tests hypotheses using numerous quantitative studies to systematically assess the results of previous research
Meta-analysis
Type of research: Analyzes data across qualitative studies in order to build new theories
Meta-synthesis
An interval, with limits at either end, with a specified probability of including the parameter being estimated.
confidence interval
A small confidence interval implies
a very precise range of values
Indicates the average amount of deviation of values from the mean
standard deviation
The probability level of which the results of statistical analyses are judged to indicate a statistically significant difference between groups
level of significance
The probability of false rejection of the null hypothesis in a statistical test
level of significance
A measure of the interdependence of two random variables that ranges in value from -1 to +1
perfect correlation
Perfect correlation: -1
perfect negative correlation
Perfect correlation: 0
Absence of correlation
Perfect correlation: +1
perfect positive correlation
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
Reflects the estimated repeatability of a measurement
reliability
The degree to which a variable measures what it is intended to measure
validity
The legal responsibility that an NP has for actions that fail to meet the standard of care, resulting in actual or potential harm to a patient
liability
Failure of an individual to do what a reasonable person would do, resulting in injury to the patient
negligence
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..
professional misconduct
unreasonable lack of skill
illegal/immoral conduct
Other allegations resulting in harm to a patient
An intentional act by one person that creates an apprehension in another of an imminent harmful or offensive contact
assault
An illegal, willful, angry, violent, or negligent striking of a person, his clothes, or anything with which he is in contact
battery
Carried out by a threat of bodily harm coupled with an apparent, present ability to cause the harm
assault
Communication that causes someone to suffer a damaged reputation
defamation
Defaming, distributed written material
libel
Spoken defamation
slander
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
involuntary commitment
An NP is potentially liable if a patient is discharged while in danger of hurting himself or others
involuntary commitment
sensitivity
True positives
specificity
true negatives
Level of prevention: Begins in childhood and focuses on lifestyle choices to prevent the development of risk factors
primordial
Level of prevention: Involves modifying existing risk factors to prevent the development of disease
primary
Level of prevention: reduces the impact of an illness or prevents a progression or return to the problem
secondary
Level of prevention: soften the impact of an illness that has life-altering effects
tertiary
Level of prevention: Focuses on screening, early identification and treatment of existing problems
secondary
Special research participants
Individuals with diminished ability to give informed consent
Risk for exploitation
Should only be used for therapeutic research from which they have some hope of benefit
null hypothesis
suggests that no real relationship exists between two groups that cannot be explained by chance alone
nondirectional hypothesis
suggests a relationship exists between two variables but does not predict the relationship
directional hypothesis
states a positive or negative relationship exists between two variables
Core competencies of collaborative inter professional practice
Patient-centered care
Utilization of informatics
Use of evidence-based practice
Application of quality improvement
recognizes personal belief and value systems including religion and religious symbols
resiliency
emphasizes alternative care practices and cultural practices
stability
Includes seeking input from patients and families related to care practices
participation in care
Includes answering questions honestly
participation in decision making
“incident-to” billing
Basic services (e.g. weight, temp) provided by a physician or done within the physician’s office with the physician in close proximity
Not allowed in hospital setting
What does Medicare not cover?
If you’re healthy, it does not cover general health counseling, maintenance health screenings, or regular physical exams
