Select a state or federal law or regulation related to patient safety that has been implemented within the last five years requiring hospitals or any other health care organizations to change the way they manage the delivery of care. Discuss the changes that have occurred because of this law or regulation.
Additionally, discuss the technology associated with either your selected law/regulation or a similar one. Are there ethical dilemmas that have resulted from technology changes when delivering care to patients or patient safety? Explain the dilemmas and how they might be resolved.
On October 16, 2015 the Centers for Medicare & Medicaid Services made their final ruling on the ‘Medicare and Medicaid Programs; Electronic Health Record Incentive Program-Stage 3 and Modifications to Meaningful Use in 2015 Through 2017’. This ruling states qualifications each eligible professional, hospital, and critical access hospital must meet to receive their Medicare and Medicaid electronic health record (EHR) incentive payments and avoid any penalties stated by the Medicare EHR Incentive Program by the year 2019 (Federal Register, 2015). This new regulation has forced hospitals and most health care providers to switch from paper charting to the use of EHR’s.
Technology associated with this regulation include electronic prescribing, computerized provider order entry, clinical decision support, coordination of care through patient engagement, and the exchange of health information between providers (American Academy of Pediatrics, n.d.). Overall, it has really advanced technology and made health care safer and more easily accessible for patients. One ethical dilemma associated with the use of EHR’s is the breech of patient confidentiality and privacy. I have personally witnessed many nurses get up and walk away from their computer with their patients’ chart still open and even worse, I’ve seen them walk away from their computer on wheels (COW) and leave the screen open in the middle of the hallway.
AAP. (n.d.). Meaningful Use Overview. American Academy of Pediatrics. Retrieved from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Informatics/Pages/Meaningful-Use-Overview.aspx
Federal Register. (2015, October 16). Medicare and Medicaid Programs; Electronic Health Record Incentive Program-Stage 3 and Modifications to Meaningful Use in 2015 Through 2017. Federal Register the Daily Journal of the United States Government. Retrieved from https://www.federalregister.gov/documents/2015/10/16/2015-25595/medicare-and-medicaid-programs-electronic-health-record-incentive-program-stage-3-and-modifications
Among the different bills that had been implemented within the last five years, there is one that addresses important elements supporting not only the safety of our patients but the safety of the nurses too, the SB No.227. The Senate bill No.227 creator was Senator Connie M. Leyva; was passed by the California State Senate and then was approved by the California Governor in October 2019. This bill’s intention was to promote patient safety by strengthening the requirements related to nurse-staffing ratio. This bill provides the California Department of Public Health (CDPH) with the power to supervise, conduct unannounced inspections and fine the healthcare facilities who don’t comply with the nurse to patient ratios (SB-227 Health and care facilities: inspections and penalties, 2019).
Senator Leyva mentioned after the bill was passed that “once SB 227 takes effect, CDPH will have another tool to hold hospitals accountable for violating nurse staffing ratios, which will require facilities to promptly correct their potentially dangerous actions and not further jeopardize the safety of patients” ( Leyva bill protecting hospital patients signed into law | Senator Connie M. Leyva, 2019). The bill followed the regulations set before by Assembly Bill 394 from 1999 which “set the minimum ratio of nurses to patient by unit, including one-to-one in operating rooms and one-to-five in general medical-surgical units” ( Leyva bill protecting hospital patients signed into law | Senator Connie M. Leyva, 2019).
There is not a lot of technology related to SB 227, but according to Mossberger (2018), “while technology is not a panacea for nurse staffing challenges, it does have the potential to play a significant role in the way hospitals ensure they strike the best balance so that patients always come first and receive the best possible care”. By the use of technology, nurses can improve the quality of the care provided to their patients, the work flow and also their work conditions. “The ability to connect to the EMR allows these systems to leverage clinical data in determining the number of nurses needed for each shift, and the equitable distribution of assignments based on the workload associated with specific diagnosis-related groups” (Mossberger, 2018).
All these changes can bring a lot of improvements to our health systems and towards better patient care, nevertheless, it comes with some ethical concerns that we always need to be aware of. One of the most frequent concerns is the fact that data breaches can happen, and sensitive information can be stolen or modified. For that reason, nurses need to follow strict measures while combining technology and patient information.
Leyva bill protecting hospital patients signed into law | Senator Connie M. Leyva. (2019, October 13). Retrieved from https://sd20.senate.ca.gov/news/2019-10-13-leyva-bill-protecting-hospital-patients-signed-law
Mossberger, M. (2018, March 22). Using technology to address nurse staffing challenges. Retrieved from https://www.healthitoutcomes.com/doc/using-technology-to-address-nurse-staffing-challenges-0001
SB-227 Health and care facilities: inspections and penalties. (2019, October). Retrieved from https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB227
Evidence-based practice is extremely important in nursing. Throughout your master’s program, you will complete research on various topics. Knowing how to construct a strong problem statement and complete a critical analysis of the available information to write a literature review is essential.
This week, you will write a problem statement and perform a literature review in preparation for your ethical issues debate presentation. Share your problem statement in this discussion so that you can review each other’s work and provide peer-to-peer feedback. Also, describe what you think are the most important learning takeaways from the literature review resources you reviewed.
Follow the instructions in the bullets below to direct you where to find resources on problem statements and literature reviews:
Go to the Student Resources tab on the top of your Blackboard page.
Click on Writing Resources.
Click on Research and Writing.
Click on Writing Strategies.
Then view:
Writing a Problem Statement
What is a Literature Review
Conducting a Literature Review
The Resource writing center stated that a strong problem statement is necessary to define “Why the problem is important”. The tutorial goes on to illustrate that a weak statement may negatively impact the overall goal. It should be specific, only state what you will discuss in your paper, and only address evidence supported or peer reviewed sources.
My learning take away from this video was that a strong problem statement sets the stage for failure or success in a research paper.
One article I have reviewed is focused on outcomes in Parkinson’s patients. I truly was in disbelief watching these patients gain fine motor control skills, reduce shaking, and in some cases, walk again during the use of medicinal marijuana. (Abernathy, 2018)
There is strong and ever increasing, scientifically verifiable evidence that medical marijuana use can be life altering in many dangerous and severe disease processes that significantly reduce symptoms, increase quality of life, and clinically slow the advancement of debilitating disease which promotes overall, more positive health outcomes for our patients that trust us as nursing professionals to provide clinically competent and compassionate healthcare.
References
Abernathy, K. (2018). Medical Marijuana and Parkinson’s. American Medical Journal, 69-78.
PROMPT 4 :
Problem statement: A lack of a standardized, federal list of mandatory vaccinations for children puts many other people at risk. Misinformation or lack thereof, is the primary reason why parents hesitate to vaccinate/immunize their children.
From a review of the literature, religious (vaccines made of fetus tissue), personal reasons (naturally gained immunity is better than immunity gained from infections), and safety concerns (vaccination side effects) play a large role in parents refusing to vaccinate their children. These views primarily stem from misinformation dervied from media sources or word of mouth ( McKee & Bohannon, 2016) .
References:
McKee, C., & Bohannon, K. (2016). Exploring the Reasons Behind Parental Refusal of Vaccines. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 21(2), 104–109. https://doi.org/10.5863/1551-6776-21.2.104
PROMPT 5 AND 6 TOPIC : Specifically define the role of the registered nurse in patient advocacy. Describe situations in which nursing advocacy can assist patients within the healthcare environment. Defend why nurses are, or are not, adequately prepared, in prelicensure education, to act as patient advocates.
PROMPT 5 :
As stated by Gerber (2018), the foundation of nurses being patient advocates was brought on by Florence Nightingale when she established the nursing role to contain providing quality of care that included a safe and clean environment, and basic human rights for all. Nursing ethics also establish a need to be a patient advocate by having characteristics like empathy and a sense of responsibility.
Every patient deserves a nurse to advocate for them because we know the ropes to healthcare and with our knowledge we can have the patient get the most out of the care that they deserve. There are times when providers ignore or bypass certain patient needs and as nurses we need to relay the importance to the providers of what is needed at the time.
An experience where I have been a patient advocate is when there was a new DM patient and I asked them if they had a glucometer and they stated they did not. I went to the provider to ask him to prescribe one and he ranted on about how the patient should go to the DM classes and then get one. I let the provider know this was a new case and he needed to be checking his blood sugar to make sure that he was keeping it at a good range and that the medication was working. The provider was still grumpy about it, so I decided to go to a different provider and explained the situation. They agreed the patient needed one and would write in an Rx for them. In the end the original provider put in for one.
I believe no matter what position you are in, you should always be a patient advocate. Before I was a nurse, I was a medical assistant and I would always communicate with the providers what the needs of the patient were. Sometimes I did see what the doctor was trying to do and other times I had to go to a different provider or even to my supervisor.
Reference:
Gerber, L. (2018, April). Understanding the nurse’s role as a patient advocate : Nursing2020. Retrieved from https://journals.lww.com/nursing/Fulltext/2018/04000/Understanding_the_nurse_s_role_as_a_patient.15.aspx
PROMPT 6 :
“The American Nurses Association (ANA) provides this definition of nursing practice: ‘The protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.’ The ANA also addresses the importance of advocacy in its Code of Ethics, specifically in Provision 3: “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient. Clearly, advocacy is a key tenet of nursing practice”.
We as nurses are the front line for helping provide quality care and accelerating the healing process for our patients. Sometimes there are certain situations such as abuse cases, where nurses are the ones who advocate and save the patients from harm.
In my own experience, patient advocacy was a big principle that was instilled into my prelicensure education so I felt that I was prepared well for that aspect of nursing. However, not all nurses emphasize advocacy because they are scared of the repercussions that come with standing up for their patients in cases of conflict. For example, being scolded or bullied by other nurses or management, standing up to doctors who may not be open to our ideas, etc.
Critical Care: The Role of Nurses as Patient Advocates. (2019, February 20).
Retrieved from https://online.alvernia.edu/articles/nurses-as-patient-advocates/
PROMPT 7AND 8 TOPIC : The ANA Code of Ethics currently emphasizes the word “patient” instead of the word “client” in referring to nursing care recipients. Do you agree with this change? Why or why not?
Review the ANA Code of Ethics for Nurses with Interpretive Statements found in Appendix B of your Butts tex
TOPIC 7:
“The word patient comes from the Latin “pati” for “suffering” meaning “the one who suffers. The word client was adopted by the mental health field as a rejection of the medicinal significance of patient.” (Spector, 2019). Personally, I feel weird calling patients “clients”, to me it seems informal and detached, but maybe that is because I grew up with that term and that is what I am used to. Things are always evolving in the medical field to improve patient care, but is this something that actually matters? I was not able to find anything of significance whether the patient or client feels any certain way about the matter.
Reference:
Spector, H. (2019, June 18). Client or patient? Using the right lingo in your practice. Retrieved from https://www.simplepractice.com/blog/client-patient-using-right-lingo-practice/
PROMPT 8 :
“The term patient has ancient roots in suffering; for millennia the term has also connoted one who undergoes medical treatment. Yet, not all who are recipients of nursing care are either suffering or receiving medical treatment The root of client implies one who listens, leans upon, or follows another. It connotes a more advisory relationship, often associated with consultation or business.” (Butts, pg. 460)
I agree with this terminology because “client” Is not a medical term. Client is more used in setting like law, business, etc. so I think that patient should be used in any medical setting whether inpatient or outpatient.
Butts, J. B. Nursing Ethics. [VitalSource Bookshelf]. Retrieved from https://online.vitalsource.com/#/books/9781284099096/
