Funding for nursing education under Medicare: a window of opportunity.
Explore the source record for details and available documents.
Education, Nursing, Graduate↗
Biomedical subjects
L B Helms
Publications and source records attributed to L B Helms.
Quality improvement in discharge planning: an evaluation of factors in communication between health care providers.
Extending quality improvement principles to coordinating patient care among multiple levels of health care service providers has received only limited attention. Referrals function by communicating information about patients' continuing care needs between health care organizations as they transfer responsibility for providing different levels of care. Our evidence suggests several procedural improvements with immediate benefit for improving the quality of referrals. These include employing standardized, written referral forms; assigning responsibility for communication by requiring a signature on each referral; and instituting an information feedback system between sending and receiving health care providers.
Aged↗
Litigation involving medical faculty and academic medical centers, 1950-1991.
An analysis is presented of 240 cases of litigation involving medical faculty, medical schools, and academic medical centers reported over the period 1950-1991. The number of reported cases increased dramatically over the study period in association with the expansion of the national medical educational enterprise. These cases can be conveniently divided by the issues they dealt with into three broad areas: general administration (89 cases), clinical affairs (108 cases), and research issues (43 cases). Cases of litigation related to general administration were most often concerned with the hiring, promotion and/or tenure, and discharge of faculty, with nearly half of these alleging discrimination. General administrative disputes also arose over allocation of departmental resources and responsibilities, faculty conduct, Veterans Affairs, relationships, employee benefits, system-wide discrimination, and collective bargaining. Courts generally supported the exercise of administrative discretion, yet examined procedures carefully. Litigation related to clinical affairs increased dramatically in recent years. Issues litigated reflect the complexity of the existing academic health care system and environment: sovereign immunity and/or malpractice, practice plans, staff privileges, indemnification, access to peer review records or other records, and conduct of practice. Outcomes of clinically related litigation through 1991 indicate substantial leeway for medical faculty, medical schools, and academic medical centers to innovate and advance their patient mission. Litigation related to medical research also accelerated recently. Issues litigated involved grants and/or personnel management, research risks, commercialization, research funding, ethics, and research animals. Litigation has paralleled (1) federal policy initiatives designed to stimulate collaboration between industry and academia and (2) the growth of regulations designed to monitor policy areas affecting research. The exposure of academic medical administrators and faculty to litigation has increased in the last 40 years. Medical schools and academic medical centers should take active steps to reduce future risks of litigation.
Academic Medical Centers↗
A comparative study: guardianship petitions for adults and elder adults.
1. The appointment of a guardian is the result of a court proceeding that transfers to another an individual's authority to make personal decisions. 2. Gerontological nurses may be asked to assist clients and families in the resolution of problems concerning personal and health care treatment decisions. 3. This study showed that adults younger than 65 years old needed a guardian due to mental retardation, mental illness, or accidental injury. Adults over 65 years old needed a guardian because they had mental retardation, alcoholism, dementia, or other physical disabilities. 4. Immediate family members were most often the individuals to serve as guardians.
Adult↗
Forty years of litigation involving medical students and their education: I. General educational issues.
An analysis of reported state and federal adjudication from 1950 through 1989 was undertaken to identify trends in litigation involving medical students and undergraduate medical education. Of the 110 decisions cited, 51 (46%) involved disputes over general educational issues. A majority of the decisions affecting general education involved admissions and dismissal processes. Recently courts have begun scrutinizing readmission, course repetition, and cheating. Medical schools have accommodated to judicial scrutiny of general educational issues and have prevailed more often than claimants in litigation during this period, but litigation has not decreased as precedent and procedure have become clearer. Instead, litigation has continued unabated in alternative areas and at different levels of the educational process.
Education, Medical, Undergraduate↗
Forty years of litigation involving medical students and their education: II. Issues of finance.
An analysis of reported state and federal adjudication from 1950 through 1989 was undertaken to identify trends in litigation involving medical students and undergraduate medical education. Of the 110 cited judicial decisions during that time, 59 (54%) involved disputes over financing medical education; 43 (73%) were litigated since 1985. This dramatic increase arises primarily from challenges to National Health Service Corps obligations and from attempts to discharge or reorganize debt under the Bankruptcy Code. Medical school graduates enjoyed very little success in these cases. Analysis of court decisions points to a need for informed counseling for medical students, particularly as to the consequences of timing in default on service obligations and of incurring loans under the Health Education Assistance Loan (HEAL) program as opposed to other loan sources. The growing educational debt of today's medical students foreshadows continued litigation in this area.
Education, Medical, Undergraduate↗
Forty years of litigation involving residents and their training: I. General programmatic issues.
An analysis of reported state and federal adjudication from 1950 through 1989 was undertaken to identify issues and trends in litigation involving residents and their training. Of the 174 decisions cited, 38 (22%) involved disputes over general programmatic issues. The great majority of these addressed academic administration, especially issues arising from dismissals of residents. During more recent periods, residency programs have accommodated to judicial scrutiny of dismissals and have prevailed more often than claimants in litigation. Successful accommodation by residency programs has apparently not operated as a disincentive to further litigation, however.
Accreditation↗
Forty years of litigation involving residents and their training: II. Malpractice issues.
The authors reviewed 136 cases of malpractice litigation involving residents or programs of graduate medical education that were reported from 1950 through 1989. Before 1970 malpractice constituted the only area of reported litigation for residents. The number of malpractice cases involving residents increased substantially after 1975, paralleling the growth of malpractice cases nationally. The regional pattern of reported cases involving residents also corresponded with previous findings. Questions of vicarious liability, the applicable standard of care, and residents' supervision were at issue in the great majority of cases. Questions related to judicial procedure, immunity from liability, breach or causation, and informed consent were also litigated. Residents were on the side of the prevailing party in 44% of the cases. Malpractice continues to be the key legal issue facing programs of residency training.
Internship and Residency↗
Disability discrimination in nursing education: an evaluation of legislation and litigation.
The Americans With Disabilities Act of 1990, the Civil Rights Restoration Act of 1987, and Section 504 of the Rehabilitation Act of 1973 have created rights for students with disabilities who choose to pursue an education in the health care disciplines. These statutes have also created new concerns for nursing educators as they assess students' qualifications for admission, retention, or dismissal. This article explores legislation and the judicial interpretation of the laws that affect disabled students in health care professions. Specifically, the article reviews and analyzes the reported case law in which health care students have claimed discrimination against education programs because of their disabilities. The analysis considers the requirements of the institution to assess or recognize if the student has a disability; to determine if the student is otherwise qualified to perform the essential responsibilities of the student role; and to establish reasonable accommodations for the student's learning environment. Finally, current and future implications for nursing education programs are presented.
Architectural Accessibility↗
Responsibilities of nursing education: the lessons of Russell v Salve Regina.
In August 1985 Sharon Russell was dismissed from Salve Regina College just before her senior year of nursing education. The reasons given for her dismissal focused on Russell's obesity and her inability to lose weight. The issues raised by this case pose important questions that nursing programs and nurse educators must address. This article explores the questions raised by Russell: (1) What constitutes substantial compliance with both academic and nonacademic performance criteria in a contract between a student and an educational institution? (2) What duties to preserve the privacy interests of students may be imposed on programs and educators? Ms Russell's case has been settled. She established that she had met the terms of the contract and substantially complied with the academic and nonacademic criteria of the nursing curriculum. She was awarded monetary damages for the college's breach of contract in nonperformance of an agreement to educate. She did not prevail in her claims of intentional infliction of emotional distress or invasion of privacy. She did, however, put nursing education programs on notice that colleges and universities are not immune from these contractual challenges and must demonstrate respect and consideration for student's personal concerns.
Contract Services↗
Medicare and the financing of nursing education: implications of Board of Trustees v Sullivan.
In 1991 a federal court decided a case of first impression about the appropriateness of reimbursement to programs of nursing education under Medicare. The court confirmed that the University of Mississippi could continue receiving Medicare reimbursement for a proportionate share of the costs of clinical education for nurses in its affiliated hospital. However, it ruled that the $2 million in costs for classroom nursing education incurred by the School of Nursing would not be reimbursed despite the fact that both the hospital and nursing school were controlled by the same entity, the university system. This article reviews the court's decision in Board of Trustees of State Institutions of Higher Learning v Sullivan within the context of the available nursing literature on this topic. It describes the provisions of the Medicare statute, which allow for reimbursement of programs of nursing education, and the implications of the court's decision for nursing education. Finally, it suggests directions for additional research and discussion about the availability of an additional source of federal funding.
Education, Nursing↗
A legal primer on affirmative action in nursing education.
Affirmative action policies are under challenge. To date, judicial concerns must be understood historically. The legal question is to define the conditions under which racial categories may be used for remedial or beneficial purposes to overcome the effects of past discrimination. Beyond exercising strict scrutiny over the use of racial classifications, courts have supported the diversification of academe. For nursing programs, the challenge is to develop policies and procedures to broaden participation without reliance on racial categories. The benefits of diversifying the nursing work force need not be discarded in response to judicial and political reaction to affirmative action.
Civil Rights↗
Unplanned hospital readmissions: a home care perspective.
BACKGROUND: The extensive literature concerning hospital readmissions is grounded in a medical or hospital perspective, and fails to address hospital readmissions during home care. OBJECTIVES: To describe clients who have unplanned returns to an inpatient setting during the first 100 days of home care service delivery. METHOD: Using the Hospital Readmission Inventory (HRI), an audit tool with previously established validity and reliability, 916 medical records for clients from 11 midwestern home care agencies were reviewed retrospectively. RESULTS: Typically, clients were referred for their first home care admission after a 9-day hospital length of stay for a cardiovascular, respiratory, or neoplastic disorder. After an average 18-day length home care stay, clients were readmitted to the hospital, usually due to the development of a new problem, or due to deterioration in health status related to the primary or to a secondary medical diagnosis. Significant respiratory, cardiovascular or GI symptoms were generally present at hospital readmission. Typically, readmitted clients were 75 year old married females, who had been able to care for themselves at home. At hospital readmission, home care nurses judged these clients to be moderately ill, and likely in need of acute care. CONCLUSIONS: Chronic illness appears to be the best indicator for hospital readmission. The crucial time period for hospital readmission during home care is the first 2-3 weeks following hospital discharge. Intensive study of home care service arrangements utilized by readmitted patients, as well as agency variations, are needed. Study findings concerning patients readmitted from home care point to similarities with rehospitalized patients generally. Findings may assist home care clinicians in targeting high risk patients who could benefit from interventions aimed at minimizing unplanned returns to the hospital.
Adolescent↗
Who's in charge? Guardianships and children.
Explore the source record for details and available documents.
Adolescent↗
Suing programs of nursing education.
Although they represent only a small percentage of litigation against institutions of higher education, suits against schools of nursing are more likely than others to be brought by students. And the students often win.
Civil Rights↗