J. Diaz DNP, MSN, BSN 1 FNP NR -506 ANCC Non -Clinical Information Level of Evidence Hierarchy: Ms. Reccee: 1. Meta -analysis 2. Systemic review 3. Randomized Controlled Trial (RCT) 4. Experiment 5. Cohort Study 6. Case Reports/Series 7. Expert Opinions/Editorials Types of Research • Meta -analysis • Systemic review • Randomized Controlled Trial (RCT) • Experiment (Classic Research) • Cross -Section • Longitudinal Design • Case Study (Report/ series) • Field study or Naturalistic study • Survey study • Cohort research Statute of Limitations: • The time limit of when a lawsuit can be filed or action against a nursing licensee for alleged violation can occur. Most states are 2-3 years. • A period of limitation for the bringing of certain kinds of legal action. Standards of Practice • Authoritative statements of the duties that all registered nurses, regardless of role, population, or specialty are expected to perform • It is developed by professional societies (ANA) and specialty organizations (AANP) Emancipated Minor • Can sign own legal documents • Legally married or divorce • Active duty in the armed forces • These are people under the age of 18 y/o but do not require an adult for consent. • Legal court document J. Diaz DNP, MSN, BSN 2 HITECH J. Diaz DNP, MSN, BSN 3 • Heath Information Technology or Economic and Clinical Health Act • Promotes adoption and meaningful use of health information technology • ACT approved in 2009 for the use of electronic health information. • Protection of PHI enacted in 2009. PHI must be encrypted prior to sending. • Patients must be informed if their PHI has been disclosed inappropriately even if the disclosure was accidental. • Providers will be offered financial incentives for demonstrating meaningful use of EHR until 2015 then penalties. • HITECH - signed by President Obama to transition to electronic health records. No more paper charting. The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act was signed into law with the explicit intention of accelerating the adoption and promoting the “meaningful use (MU)” of electronic health records (EHRs) by US physicians. Patient in EOL (end of life) stage ask of hospice: • The patient is already end stage so beneficence is not correct unless you are educating about smoking cessation or vaccination. This is to promote good. Utilitarianism is the greater good for a population of patie nts. Justice is to be fair. Which leaves us to autonomy. This is allowing the patient to make his own choice after giving him all the information to make a good informed decision. • AFTT (adult failure to thrive). This is a secondary diagnosis for hospice eligibility. So when you consult hospice for weight loss and not eating with no other major diagnoses, this is not a good referral. Hospice is no longer able to use this as a primary diagnosis. Prescriptive Authority • The majority of states require NPs to have a collaborative agreement with a physician in order to prescribe. • All states now allow NPs to prescribe certain controlled drugs, but with limitations DEA • Drug Enforcement Administration • NP must obtain prescriptive authority before getting a DEA number to prescribed controlled substances. • Allows advanced practice nurses to obtain registration numbers for prescribing controlled medication • Though DEA is federal, prescriptive authority is managed by the state board Certification • Generally a "voluntary" process and is done through a nongovernmental entity such as professional nursing association or specialty organization. • Many states mandate certification as a condition to obtain licensure Licensure J. Diaz DNP, MSN, BSN 4 • Legal requirement to practice as an NP • Obtained through a governmental entity, the SBON • Must meet minimal educational and clinical requirements in order to become licensed Incidence • Conveys information about the risk of contracting a disease • Measure of disease that allows us to determine a person's probability of being diagnosed with a disease during a given period of time. • Rate of new cases of the disease Prevalence • How widespread the disease is • Measure of disease that allows us to determine a person's likelihood of having a disease, number of alive cases with the disease What are the 4 ethical principles? (and define) • Beneficence (promoting well-being for pt. and society) • Nonmaleficence - "above all, do no harm" • Autonomy (person acts intentionally after being given informed consent) • Justice (equitable distribution of social benefits) Beneficence • To do good. The obligation to help the patient; to remove harm, prevent harm, and promote good • Acting in the patient's best interest • Compassionate patient care • The core principle in patient advocacy. • Encourage a patient to stop drinking and enroll in AA program. • Education on a new prescription about how to take the medication, health promotion, education, smoking cessation. Nonmaleficence • Obligation to do no harm; protecting a patient from harm • Your patient has asthma. She brown bags her medication on this visit and you notice a beta-blocker. You educate her that she is not a good candidate for these drugs • Example: Discussing risks vs. benefits of a treatment; working within SOP (standard operating procedures). Utilitarianism • The outcome of the action is what matters with utilitarianism. It also means to use a resource for the benefit of most (e.g., tax money). It may resemble justice, but it is not the same concept
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