N170 Test 3- EBP, Health Care Law, and Health Policy

occurence report

Serves as database for further investigation and alerts risk management to a potential claim situation

1989 Webster v. Reproductive Health Services

Some states require viability tests if the fetus is more than 28 weeks' gestational age.

Mental Health Parity Act as Enacted Under PPACA

Strengthens mental health services

Process of policy development

agenda setting, policy formulation, policy adoption, policy implementation, policy evaluation

The Patient Safety and Quality Improvement Act

allows certain disclosures of patient safety data

Negligence

careless neglect, often resulting in injury

Courts and the judiciary:

determines rights in health policy disputes through judicial review

Executive Branch

executes and implements laws

Policy is:

goal oriented public authoritative nature

State Health Policy

governs nursing through the nurse practice act Provides invisible services through regulatory activities Ensures safe food storage and preparation in restaurants Regulates healthcare facilities Pays for healthcare services through Medicaid

State Statutory Issues in Nursing Practice

licensure, good samaritan law, public health law, uniform determination of death act, autopsy, and death with dignity or physician assisted suicide

Quantitative Research

structured responses that can be statistically tested to confirm insights and hypotheses generated via qualitative research or secondary data Ex) Randomized controlled studies, cohort studies, longitudinal cases, case-controlled studies, and case reports. Randomized, controlled, double-blind studies have the least amount of bias

practice guidelines

systematically developed statements to assist healthcare providers with making appropriate decisions about health care for specific clinical circumstances

Ethnography

the method by which researchers attempt to understand a group or culture by observing it from the inside, without imposing any preconceived notions they might have

legislation

the process of introducing, adopting, changing, or repealing law

Battery

touching a person without consent

False Imprisonment

unjustified detention of a person

Steps involved in risk management?

Identify possible risks Analyze risks Act to reduce risks Evaluate steps taken

Data

Implies a collection of facts

Tools used in risk management?

Incident report or occurrence report, documentation, TJC's Universal Protocols, Professional involvement

How are hospitals paid by Medicare?

Medicare payments are reduced or eliminated for treating hospital-acquired conditions, such as falls, decubitus ulcers, and infections.

advanced directive (living will)

Written documents direct treatment in accordance with patients wishes terminal illness

mixed design

a mix of qualitative and quantitative research methods

health care proxy or durable POA for health care

a person chosen to make medical decisions if a patient is unable to do so, as when in a coma

Malpractice Insurance

a type of liability insurance that protects against financial loss arising from suits for negligence in providing professional services

EBP

problem solving approach to making clinical decisions using the best evidence available; Best, newest, and top research

What are some abandonment and assignment issues?

-Short staffing- Legal problems if inadequate number of nurses -Floating- Based on census load and patient acuities Health care providers orders- Nurse follows orders unless the believe an order is given in error or is harmful

Sources of Law

statutory law (Nurse Practice Act) -Criminal law (felonies or misdemeanors) -Civil law (nursing negligence/malpractice) regulatory law (administrative law) common law (judicial decisions)

State Policies

-Violations of the nurse practice act or rules and regulations •Licensing boards have the authority to hear and decide cases against nurses •Penalties that may be imposed: •Issuing a formal reprimand •Establishing a period of probation •Levying fines •Limiting, suspending, or revoking the nurse's license

tort

A civil wrong against person or property

Bias

A particular preference or point of view that is personal, rather than scientific.

Uniform Anatomical Gift Act

A state statute allowing persons 18 years of age and of sound mind to make a gift of any or all body parts for purposes of organ transplantation or medical research

Risk Management and Quality Assurance

A system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs

Validity

Accuracy of application and findings

informed consent

Agreement to allow care based on full disclosure of risks, benefits, alternatives, and consequences of refusal; Nurse as witness to consent

Research Process Steps

Assessment; Identify area of interest or clinical problem Diagnosis; Develop research questions/hypothesis Planning; Determine how study will be conducted Implementation; Conduct the study Evaluation; Analyze results of the study and use of findings

Clinical decisions

Best evidence to best practice

Who can consent?

Competent adults; Parents of minors Court orders for minors;Legal guardian or representative

Patient Protection and Affordable Care Act (PPACA)

Comprehensive health care reform became a reality when passed in 2010. Major component was to provide funding for health insurance program , US citizens and legal residents secure health insurance at reasonable rates. (2016 )8.8% or 28.1 with out insurance. 2014 - 13.4% without insurance

Patient Protection and Affordable Care Act (PPACA)

Consumer rights and protections Affordable health care coverage Increased access to care Stronger Medicare to improve care for those most vulnerable in our society

Legislature

Creates laws and determines appropriate funding

Major government institutions:

Decide, implement, and regulate policy.

Americans with Disabilities Act of 1990 (ADA)

Discrimination against persons with disabilities by removing barriers that might prevent the same opportunities available to persons without disabilities.

How do we we gain representation of federal, state, and local governmental power?

Elected Representation; Indirect citizen power to change policy

Health Insurance Portability and Accountability Act (HIPAA)

Enacted by the U.S. Congress in 1996, HIPAA requires the U.S. Department of Health & Human Services (HHS) to establish national standards for electronic health care information to facilitate efficient and secure exchange of private health data.

Regulatory Agencies

Enforce the laws through a rule-making process.

Sources of Scientific Literature

Medical librarian and scientific literature databases

Malpractice

Failure by a health professional to meet accepted standards

What are some examples of negligence?

Failure to assess or monitor, making a NDx. •Failure to use, calibrate, replace equipment •Document care and evaluation of care in a timely manner •Notify health care provider of change in status •Failure to implement NEW or existing orders •Failure to follow 6 rights of medication adm •Failure to convey discharge instructions to patient or family •Failure to ensure patient safety, especially those with history of falling, sedated, frail, mentally impaired or get up at night. •Failure to follow policies or procedures •Failure to properly delegate and supervise

Assault

Fear of harm, no contact

Health policy can be made at which levels?

Federal, state, and local levels

Reliability

Findings are consistent

Replicability

Findings are verified when repeated in other studies

Local Health Policy

Free or reduced rate immunizations, tobacco free spaces, safe drinking water, RN's as school nurses, seat belt laws. `

health policy

Health policy is goal-directed decision making about health that is the result of an authorized and public decision-making process. This includes those actions, no actions, directions, and/or guidance related to health that are decided by governments or other authorized entities.

Hospital Value-Based Purchasing Program

Hospitals will be reimbursed based on quality and patient satisfaction

State Statues

Nurse practice act and board of nursing rules and regulations •Define scope and limitations of nursing practice •Vary from state to state, but common elements include: •Definition of the term registered nurse •Description of professional nursing functions •Standards of competent performance •Behaviors that represent misconduct or prohibited practices •Grounds for disciplinary action •Fines and penalties for violations •Each nurse should own a copy and should understand the content -Nurse/patient ratio and mandatory overtime statues

When can restraints be used?

Only to ensure the physical safety of the resident or other residents, when less restrictive interventions are not successful, and only on the written order of a healthcare provider.

PICOT question

P- patient population of interest I- intervention of interest C- comparison of interest O- outcome T- time

Emergency Medical Treatment and Active Labor Law (EMTALA)

Prohibits refusal of care for indigent and uninsured patients seeking medical assistance in emergency departments Prohibits transfer of unstable patients, including women in active labor, from one facility to another Applicable to nonemergency facilities (i.e., urgent care clinics)

Evidence

Testimony of facts prove or disprove

Health care law

The collection of laws that have a direct impact on the delivery of health care or on the relationships among those in the business of health care or between the providers and the recipients of health care.

regulation

The process of putting laws into action through the establishment of rules.

litigation

The process of seeking help through the courts to address a perceived wrong

scientific rigor

The strict application of the scientific method to ensure unbiased experimental design, methodology, analysis, interpretation and reporting of results.

Civil and Common Law Issues in Nursing Practice

Tort (civil wrong against person or property) Intentional ( willful acts on another) Assault (fear of harm, no contact) Battery (touching without consent) False imprisonment (unjustified restraint)

Many policy initiatives require collaboration between the federal government and state government? True/False

True

Medicare payments are reduced for preventable hospital readmissions. T/F

True

Levels of Evidence

U.S. Preventive Services Task Force Grading of Evidence; need to know pyramid/levels for test

Roe v. Wade (1973)

U.S. Supreme Court ruled that there is a fundamental right to privacy, which includes a woman's right to have an abortion

Qualitative Research

informal research methods, including observation, following social media sites, in-depth interviews, focus groups, and projective techniques Ex) Person's experience, interviews, surveys, or questionnaires. Ethnography, phenomenology, grounded theory, and case reports

Quasi-intentional torts

invasion of privacy, defamation of character

Unintentional Torts

negligence and malpractice

expert opinion

recommendations of individuals who have expertise in a particular area that are sometimes the basis of a group's decision-making process

Patient Self-Determination Act of 1990

requires federally funded hospitals (Medicare, Medicaid) to inform adult patients in writing about their right to make treatment choices and to ask patients if they have a living will or durable power of attorney

Slander

spoken defamation

intentional

willful acts on another

Libel

written defamation

What are some health policy issues?

•Uninsured populations/access to care •Rising costs •Health care disparities •Health professional shortages •Increasing diversity in nursing •Quality and safety (patient care)

What are the minimum standards of care?

➢Legal guidelines for defining nursing practice and identifying the minimum acceptable nursing care ➢Best known comes from the American Nurses Association (ANA) ➢Set by state and federal laws that govern where nurses work ➢Joint Commission requires policies and procedures (P&Ps).