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PubMed2000

Comparison of nurse practitioner and family physician relative work values.

PURPOSE: With the enactment of the Balanced Budget Act of 1997, American nurse practitioners were granted direct Medicare reimbursement for Part B services. Payment structures in fee-for-service and managed care systems are physician-based, leading to difficulties in constructing payments for other health care professionals. The purpose of this pilot study was to examine the feasibility of using nurse practitioner data for specifying relative work values in the Medicare Fee Schedule for three office-visit codes. DESIGN: An exploratory survey was designed to establish relative work values using magnitude-estimation scaling. Nurse practitioners (N = 43) responded to a structured questionnaire in a national mail survey. Physician data (N = 46) were obtained from a computerized database from the American Academy of Family Physicians. METHODS: The methods used in this study were the same as the process used by the American Medical Association and the Health Care Financing Administration to establish relative work values in the Medicare Fee Schedule. Respondents established relative work values for three Current Procedural Terminology (CPT) codes for office visits (99203, 99213, 99215) commonly billed in primary care practice. Each CPT code descriptor and associated vignette were compared with reference services germane to the practice of nurse practitioners and family physicians, using magnitude-estimation scaling. To establish relative work values for each code, respondents were asked to consider the time to provide the service and intensity of the work involved for each CPT code. FINDINGS: No significant differences between nurse practitioners and family physicians were found in the three CPT codes for relative work values and intensity. Nurse practitioners estimated significantly (p < .01) higher intraservice (face to face) time with patients than did family physicians, and family physicians estimated significantly (p < .05) higher pre-service time for two codes and significantly (p < .05) higher postservice times for three codes. CONCLUSIONS: Nurse practitioner relative work values did not differ significantly from family physician relative work values. Although the sample sizes were small, the significance of the findings support the need for further research with large data sets and additional CPT codes. Such studies could then be used as a basis for decisions about Medicare payment and public policy.

Humans↗
PubMed2000

Arguing for a dynamic quality in professional codes of ethics.

Many professional organizations and healthcare institutions have developed codes of ethics for a number of reasons. Unlike legal mandates, codes of ethics provide professionals with a framework for ethical behavior within their specific discipline. Professionals today face challenges because the necessary ethical debates cannot keep pace with the rapidly changing environment in which ethical dilemmas quickly emerge. This article describes components of codes of ethics, outlines the evolving nature of ethics, and argues for a dynamic quality in these codes as a way to provide timely, sensitive guidance for professional practice.

American Nurses' Association↗
PubMed2000

Critical thinking by nurses on ethical issues like the termination of pregnancies.

This research forms part of a larger interdisciplinary research project on the termination of pregnancies. The focus of this part of the project is on the ethical issues related to termination of pregnancies. The practice of the professional nurse is confronted with ethical dilemmas and disputes. Whether the nurse chooses to participate in the termination of pregnancies or not, the core function of the nurse is that of counseling and ethical decision-making. Effective counseling requires empathy, respect for human rights and unconditional acceptance of a person. Making ethical decisions implies making critical decisions. It is self-evident, therefore, that such decisions should be based on sound arguments and logical reasoning. It is of vital importance that ethical decisions can be justified on rational ground. Decision-making is a critical thinking approach process for choosing the best action to meet a desired goal. The research question that is relevant for this paper is: Are nurses thinking critically about ethical issues like the termination of pregnancies? To answer the research question a qualitative, exploratory, descriptive design was used (Mouton, 1996:103-169). Registered nurses were selected purposively (Creswell, 1994:15). 1200 registered nurses completed the open-ended questionnaires. Focus group interviews were conducted with 22 registered nurses from a public hospital for women and child health services. Data analysis, using secondary data from open-ended questionnaires and transcribed focus group interviews, were based on the approach of Morse and Field (1994:25-34) and Strauss and Corbin (1990). The themes and categories from open coding were compared, conceptualized and linked with theories on critical thinking (Paul, 1994; Watson & Glaser, 1991 and the American Philosophical Association, 1990). The measures of Lincoln and Guba (1985) and Morse (1994) related to secondary data analysis were employed to ensure trustworthiness. Based on these findings the researcher concluded that nurses are not thinking critically when making ethical decisions concerning the termination of pregnancies. Recommendations are made as a possible solution for this problem.

Abortion, Legal↗
PubMed1989

Unlicensed persons in patient care settings. Administrative, policy, and ethical issues.

The current nursing shortage is a supply-and-demand problem. Factors contributing to the shortage include increased hospital use of RNs; decreased nursing school enrollment; increased demand for RNs outside of hospitals in skilled nursing facilities, health maintenance organizations, and home health care programs; noncompetitive salaries; and lack of autonomy. The nursing shortage has triggered the development and implementation of programs to prepare non-nurse bedside technicians to work in partnership with RNs. The functions of these unlicensed persons range from housekeeping, stocking, and clerical responsibilities to several technical treatments that once fell within the role responsibilities of registered or practical nurses. The partnerships between unlicensed persons and RNs in patient care settings have given rise to several administrative, policy, and ethical issues for nurse leaders. An ethical analysis, based on the application of ethical principles and moral dilemmas found in "The Parable of the Sadhu," offers some guidelines to nursing leaders in the administrative and policy decisions inherent in the development and retention of licensed persons in patient care settings. Some conclusions drawn from the ethically based questions are: The acquisition and retention of RNs and other licensed caregivers should take precedence over the development of programs for non-nurse bedside technicians. RNs in partnership with unlicensed persons in patient care settings must know what they can legitimately delegate. The RN has personal responsibility for ensuring optimal standards of nursing practice in the delegation of duties. The partnership between professional nurses and unlicensed persons must be a participative effort, not a manipulative or coercive one. In putting the organizational principle of subsidiarity into practice, decision makers will be able to maintain respect for human dignity and the uniqueness of patients and caregivers as well. The development and retention of unlicensed persons in patient care settings depends on a well-developed personal ethic that needs to be congruent with the mission, philosophy, and codes of ethics of national and local health care organizations.

Allied Health Personnel↗
PubMedDate not supplied

Use of the code of ethics for accountability in discharge planning.

Nine selected items from the Code of Ethics for nurses are used to illustrate how the code can be used as an excellent resource for accountability with discharge planning. Research findings identify the need for expanded awareness of the code and how to apply it to the discharge planning process. Components of the teaching/learning process are compared to the code to suggest that nurses need increased educational preparation to be accountable for discharge planning.

Attitude of Health Personnel↗
PubMedDate not supplied

Balancing personal risk with professional responsibility: the case of AIDS.

Generally, nurses have an ethical and legal obligation to provide treatment to persons with AIDS. When it is unclear whether nurses are morally required to provide treatment, they should engage in moral analysis, discuss their concerns with their colleagues and administrators, work within their institution's framework to resolve their concerns, seek legal counsel, or as a last resort consider working in another practice setting.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Addressing ethical boundaries among nurses.

Sexual intimacy is the primary boundary issue studied and reported in the literature, though it is not addressed directly in the ANA Code of Ethics. However, perhaps equally important are behaviors which may stem from nurses' meeting their own social and emotional needs through their work. Results of "Boundaries" workshops for more than 3000 nurses and other healthcare professionals are summarized. Recommendations are made, relative to both personal and professional behavior, along with a list of suggestions for nurse managers.

Codes of Ethics↗
PubMed1996

Assisted suicide: clinical realities and ethical challenges.

The increasing attention to assisted suicide, as evidenced by recent legislation, initiatives, court decisions, and research, propels the issue to a new level of importance and urgency within society and the health professions. Nurses cannot help but be confronted by and struggle with the complex moral and professional quandaries related to assisted suicide. Critical care nurses must continue to evaluate the implications of the possible legalization of assisted suicide and to define the boundaries of morally acceptable professional practice. The challenges to the roles and responsibilities of critical care nurses that might occur if assisted suicide were legalized must be thoughtfully and responsibly explored.

Attitude of Health Personnel↗
PubMedDate not supplied

A review of major nursing vocabularies and the extent to which they have the characteristics required for implementation in computer-based systems.

Building on the work of previous authors, the Computer-based Patient Record Institute (CPRI) Work Group on Codes and Structures has described features of a classification scheme for implementation within a computer-based patient record. The authors of the current study reviewed the evaluation literature related to six major nursing vocabularies (the North American Nursing Diagnosis Association Taxonomy 1, the Nursing Interventions Classification, the Nursing Outcomes Classification, the Home Health Care Classification, the Omaha System, and the International Classification for Nursing Practice) to determine the extent to which the vocabularies include the CPRI features. None of the vocabularies met all criteria. The Omaha System, Home Health Care Classification, and International Classification for Nursing Practice each included five features. Criteria not fully met by any systems were clear and non-redundant representation of concepts, administrative cross-references, syntax and grammar, synonyms, uncertainty, context-free identifiers, and language independence.

Evaluation Studies as Topic↗
PubMedDate not supplied

The prevalence, composition, and function of ethics committees in nursing facilities: results of a random, national survey of American Health Care Association members.

OBJECTIVES: To determine the prevalence, composition, and function of ethics committees in extended care facilities in the United States. DESIGN: Descriptive survey by mail. SETTING: A 5% random sample (n = 851) of nursing facility members of the American Health Care Association (n = 17,020). Most of these facilities (75%) are intermediate care facilities; the remainder include a varying number of skilled beds. METHODS: An eight-item questionnaire was sent to the randomly selected 851 extended care facilities. The questionnaire inquired about the existence of an ethics committee, plans for formation when applicable, composition of the ethics committee, and its function. Survey data was coded and merged with information on facility characteristics that are part of the American Health Care Association's database. RESULTS: Of the responding facilities (n = 394), 34% reported the presence of a functioning ethics committee, with an additional 19% indicating definite plans for ethic committee formation. Forty-three percent expressed no interest in establishing an ethics committee, and 4% reported having had an ethics committee sometime in the past. The greatest proportion of committee time was spent in case review (39%) with lesser amounts of time expended in areas of policy formation (27%) and education (27%). Forty percent of the ethics committees performed two or fewer case reviews per year. Nearly all committees included the following disciplines in the membership: nurses (96%), physicians (95%), and social workers (89%). Facility administrators (77%) and clergy (70%) were frequently represented. Very few facilities reported representation by residents (8%) and Certified Nursing Assistants (2%). The Medical Director served as a committee member on 75% of the ethics committees, and in more than one-half of those instances, he/she was the sole physician on the committee. CONCLUSION: Ethics committees are currently active in or there are plans for their development in more than 50% of extended care facilities in the U.S. this represents a very significant increase in prevalence during the last decade. This tendency to form ethics committee's may slow considerably in the future. Ethics committees exhibit considerable variability in structure and function.

Journal Article↗
PubMedDate not supplied

Recommendations for responsible monitoring and regulation of clinical software systems. American Medical Informatics Association, Computer-based Patient Record Institute, Medical Library Association, Association of Academic Health Science Libraries, American Health Information Management Association, American Nurses Association.

In mid-1996, the FDA called for discussions on regulation of clinical software programs as medical devices. In response, a consortium of organizations dedicated to improving health care through information technology has developed recommendations for the responsible regulation and monitoring of clinical software systems by users, vendors, and regulatory agencies. Organizations assisting in development of recommendations, or endorsing the consortium position include the American Medical Informatics Association, the Computer-based Patient Record Institute, the Medical Library Association, the Association of Academic Health Sciences Libraries, the American Health Information Management Association, the American Nurses Association, the Center for Healthcare Information Management, and the American College of Physicians. The consortium proposes four categories of clinical system risks and four classes of measured monitoring and regulatory actions that can be applied strategically based on the level of risk in a given setting. The consortium recommends local oversight of clinical software systems, and adoption by healthcare information system developers of a code of good business practices. Budgetary and other constraints limit the type and number of systems that the FDA can regulate effectively. FDA regulation should exempt most clinical software systems and focus on those systems posing highest clinical risk, with limited opportunities for competent human intervention.

Clinical Medicine↗