International code of ethics for midwives: how do they fit your practice?
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Ethics, Nursing↗
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Nurse Practitioner competency standards: findings from collaborative Australian and New Zealand research.
BACKGROUND: The title, Nurse Practitioner, is protected in most jurisdictions in Australia and New Zealand and the number of nurse practitioners is increasing in health services in both countries. Despite this expansion of the role, there is scant national or international research to inform development of nurse practitioner competency standards. OBJECTIVES: The aim of this study was to research nurse practitioner practice to inform development of generic standards that could be applied for the education, authorisation and practice of nurse practitioners in both countries. DESIGN: The research used a multi-methods approach to capture a range of data sources including research of policies and curricula, and interviews with clinicians. Data were collected from relevant sources in Australia and New Zealand. SETTINGS: The research was conducted in New Zealand and the five states and territories in Australia where, at the time of the research, the title of nurse practitioner was legally protected. PARTICIPANTS: The research was conducted with a purposeful sample of nurse practitioners from diverse clinical settings in both countries. Interviews and material data were collected from a range of sources and data were analysed within and across these data modalities. RESULTS: Findings included identification of three generic standards for nurse practitioner practice: namely, Dynamic Practice, Professional Efficacy and Clinical Leadership. Each of these standards has a number of practice competencies, each of these competencies with its own performance indicators. CONCLUSIONS: Generic standards for nurse practitioner practice will support a standardised approach and mutual recognition of nurse practitioner authorisation across the two countries. Additionally, these research outcomes can more generally inform education providers, authorising bodies and clinicians on the standards of practice for the nurse practitioner whilst also contributing to the current international debate on nurse practitioner standards and scope of practice.
Attitude of Health Personnel↗
Code of ethics for nurses at a European level.
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Codes of Ethics↗
Codes of ethics for nurses and continuing education.
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American Nurses' Association↗
The new code of ethics: implications for perioperative nurses.
This article will look briefly at the historical development of the Code of Ethics for Nurses and then critique the New Code of Ethics. From there, aspects of the Code will be applied to perioperative nursing. The Canadian Nurses Association (CNA) revised its Code of Ethics of Nursing to all its members in November, 1992. Nurses can be guided by this document in ethical issues which they must face in their work. Perioperative nurses encounter specific situations daily, for which the Code of Ethics can be a guide.
Canada↗
Nurses' views on ethical codes: a focus group study.
AIM: This paper reports a study exploring nurses' views on the 'potential' content and functions of an ethical code for nurses in Belgium. The term 'potential' is used, because Belgian nurses do not have experience with an ethical code. BACKGROUND: Ethical codes have been developed to guide nurses' practice and to improve their professional status. Little empirical research, however, has been undertaken to determine nurses' views on the content and functions of these codes. The available quantitative studies merely give some information on nurses' (lack of) knowledge and use of their ethical code. No nursing ethical code currently exists in Belgium. Qualitative research exploring nurses' views, therefore, was needed in order to find out which functions an ethical code could fulfil and what the code's content could be. METHOD: Eight focus groups were conducted with 50 nurses in different healthcare settings in Belgium. Data were generated during 2003. FINDINGS: According to participants, an ethical code could fulfil several functions, including supporting their professional nursing identity (external function) and giving guidelines for nursing practice (internal function). In addition, some aspects of content were mentioned, including nurses' responsibilities in a relational context: particular attention should be paid to the personality of the nurse and to the specificity of nursing as a relational activity. Most agreement was reached on the 'ethical' function of the code, namely guiding nurses' professional moral practice. Regarding disciplinary use and the need for legalization of the ethical code, on the contrary, opinions were divergent. CONCLUSIONS: It is of utmost importance to take into account nurses' views when developing an ethical code for their profession. This study gave a first picture of the views of nurses themselves. These initial findings should be completed with nurses' views on the formulation, dissemination and promotion of the ethical code. Such evidence-based development of an ethical code will probably give more guarantees that the code will meet nurses' expectations and will function optimally.
Adult↗
Comparison of office visit and nurse advice hotline data for syndromic surveillance--Baltimore-Washington, D.C., metropolitan area, 2002.
INTRODUCTION: Kaiser Permanente of the Mid-Atlantic States (KPMAS) is collaborating with the Electronic Surveillance System for Early Notification of Community-Based Epidemics II (ESSENCE II) program to understand how managed-care data can be effectively used for syndromic surveillance. OBJECTIVES: This study examined whether KPMAS nurse advice hotline data would be able to predict the syndrome diagnoses made during subsequent KPMAS office visits. METHODS: All nurse advice hotline calls during 2002 that were linked to an outpatient office visit were identified. By using International Classification of Diseases, Ninth Revision (ICD-9) codes, outpatient visits were categorized into seven ESSENCE II syndrome groups (coma, gastrointestinal, respiratory, neurologic, hemorrhagic, infectious dermatologic, and fever). Nurse advice hotline calls were categorized into ESSENCE II syndrome groups on the basis of the advice guidelines assigned. For each syndrome group, the sensitivity, specificity, and positive predictive value of hotline calls were calculated by using office visits as a diagnostic standard. For matching syndrome call-visit pairs, the lag (i.e., the number of hours that elapsed between the date and time the patient spoke to an advice nurse and the date and time the patient made an office visit) was calculated. RESULTS: Of all syndrome groups, the sensitivity of hotline calls for respiratory syndrome was highest (74.7%), followed by hotline calls for gastrointestinal syndrome (72.0%). The specificity of all nurse advice syndrome groups ranged from 88.9% to 99.9%. The mean lag between hotline calls and office visits ranged from 8.3 to 50 hours, depending on the syndrome group. CONCLUSIONS: The timeliness of hotline data capture compared with office visit data capture, as well as the sensitivity and specificity of hotline calls for detecting respiratory and gastrointestinal syndromes, indicate that KPMAS nurse advice hotline data can be used to predict KPMAS syndromic outpatient office visits.
Baltimore↗
Annotated bibliography appendices: international codes of ethics.
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American Hospital Association↗
A pathway for moral reasoning in home healthcare.
Ethical issues arise in the practice of infusing nursing, and when they do, the home care nurse can find guidance in the code of ethics. This article addresses the importance of the code of ethics and introduces a framework for decision-making to assist the home care nurse in determining a course of action in the face of ethical quandaries.
Advance Directives↗
How safe is primary knee replacement surgery? Perioperative complication rates in Northern Illinois, 1993-1999.
OBJECTIVE: To describe inpatient complications for primary total knee replacement (TKR) in a period of rapidly growing orthopedic surgery capacity, declining length of stay, and more frequent discharge to rehabilitation facilities. METHODS: Complication incidence according to published coding algorithms was estimated for 35,531 primary TKR admissions of northern Illinois residents to 65 Illinois hospitals. Complication odds were estimated as a function of patients' clinical and sociodemographic status, hospital volume, residency training, TKR length of stay, International Classification of Diseases, Ninth Revision (ICD-9) coding intensity, and discharges to skilled nursing or rehabilitation facilities. RESULTS: Primary TKR admissions increased 36% between 1993 and 1999, length of stay declined 43%, average ICD-9 code use increased 31%, and rehabilitation discharges increased 68%. Major complication rates declined 44% (12.4% to 6.9%; P < 0.0001) over this period, reflecting a 50% reduction in the adjusted odds of complication between 1993 and 1999. There was no association of procedure volume and outcome. CONCLUSION: It is likely that the reduction in complications reflects true safety improvements as well as reduced length of stay.
Adolescent↗
Using a multidisciplinary classification in nursing: the International Classification of Functioning Disability and Health.
AIM: This paper reports a study to explore systematically the usefulness of the International Classification of Functioning, Disability and Health to nurses giving patient care. BACKGROUND: The International Classification of Functioning, Disability and Health has a history of more than 20 years. Although this World Health Organization classification offers multidisciplinary use, nurses are not familiar with it. METHODS: Applications of the International Classification for nursing practice were developed and evaluated in a multi-centre project, composed of a series of 10 projects in a variety of settings. These applications were a variety of tools, such as assessment forms, care plans and transfer forms. The study used information from 653 patients, 469 nurses and 178 others (International Classification experts; other professionals with whom nurses communicate or discuss patient data). FINDINGS: Large sections of the International Classification were used in the 10 projects, revealing a predominant focus on body functions (53% of all three-digit codes and corresponding terms used). Although large sections of the Classification were useful in practice applications, some items were identified that could be added, improved or described with more detail. Positive remarks made by nurses referred to the scope of the International Classification, which encouraged assessing beyond a patient's functional impairments. CONCLUSIONS: The International Classification of Functioning, Disability and Health can be a useful tool in classifying and communicating aspects of patient functioning by nurses. A level of moderate detail within the Classification (three-digit level) seems appropriate for most nursing purposes. Our results on items that could be added or improved can serve as input in future revisions of the Classification. Future use of the International Classification should be encouraged, because of its relevance to nursing and its potential for multidisciplinary use in patient care.
Activities of Daily Living↗
The nurse, the Geneva Conventions and human rights.
Alleged reports from the warfronts over the past few years have been shocking: bombing of hospitals and ambulances, health workers refusing to care for wounded members of the opposition, medical involvement in the torture of prisoners, etc. Such conduct is in violation of professional codes of conduct and the Geneva Conventions. Yet the combatants and health care personnel in too many instances remain impervious. In many economically and politically unstable countries, where uprisings and war can explode any day, anyone can become involved, but particularly health care professionals because of the nature of their work. When confronted with a dilemma in a conflict situation, nurses must remember that they are accountable for their own professional actions and as such must be aware of patient/client rights and of their rights and obligations under the terms of the Geneva Conventions of 1949 and the Additional Protocols of 1977. To assist nurses in making the right decisions, ICN developed a Code for Nurses and in 1984, with the League of Red Cross and Red Crescent Societies, prepared an educational package for nurses on the Geneva conventions and the principles of humanitarian law. Subsequently ICN, with its member nurses' associations, developed position papers on the role of nurses in caring for prisoners and detainees and in safeguarding human rights. And today in face of daily reports of humanitarian violations, ICN urges NNAs to reconfirm their commitment and to take concrete moves to assure that their members fully understand what is expected of nurses in conflict situations. Extracts of the Geneva Conventions' essential provisions and ICN's position statements are provided below as one step in bringing about this awareness.
Codes of Ethics↗
ICN's Code of Ethics for Nurses: Serving nurses and nursing care world-wide.
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Ethics, Nursing↗
Professional values and empowerment: a role for continuing education.
A commitment to values is increasingly important for professional nurses. For practitioners of nursing, advances in knowledge and technology are raising complicated ethical questions that need a response. The guiding of ethical decision-making is a primary function of a code of ethics such as the Code for Nurses document (1978). Among practitioners of nursing, values identified most frequently are reflected in the first six statements that deal with professional issues. Values inherent in the last five statements, which focus on social issues, such as professional empowerment, are not readily identified. Internalization of the social issue values is critical for the future of nursing.
Codes of Ethics↗
Factors associated with hospitalization costs for patients with community-acquired pneumonia.
BACKGROUND: Combined mortality rates for pneumonia and influenza suggest that the 2 conditions represent the sixth leading cause of death in the United States. The total cost of pneumonia, including indirect costs, was estimated to be approximately $23 billion per year in 1994. OBJECTIVE: The objective of this study was to assess variables that may be significantly associated with the cost of treating patients hospitalized with community-acquired pneumonia (CAP). We also assessed the impact of treatment guidelines for management of CAP (developed by managed care plans) on total costs. METHODS: Patients in 3 managed care plans who were hospitalized with a primary or secondary diagnosis of CAP in Maryland and Washington, DC, between January 1, 1997, and April 30, 1997, or between January 1, 1998, and April 30, 1998, were identified based on International Classification of Diseases, Ninth Revision codes. Clinical data were abstracted from patients' medical charts by nurses, and billing data were acquired from these plans. A retrospective data analysis was carried out using billing data from 3 managed care plans and clinical data from hospitals associated with the plans. A multivariate regression model was developed using the natural logarithm of cost as the dependent variable. Independent variables that were studied included severity of illness, days in the intensive care unit (ICU), triage per guidelines, drug therapy per guidelines, mortality, and managed care plan identifiers. RESULTS: The charts of 569 patients were assessed. The mean age of the study sample was 75.3 years. ICU days (P < 0.001), mortality, and drug therapy (both P < 0.01) per guidelines significantly affected costs. As expected, an increase in the number of ICU days led to an increase in costs. However, patients who received drug therapy recommended by the guidelines had significantly lower costs than patients not treated according to the guidelines (P = 0.001). CONCLUSIONS: The findings of this study suggest that guidelines for CAP management, such as those developed by managed care plans, may help reduce costs by minimizing unnecessary ICU admissions and appropriately managing patients with CAP.
Aged↗
The use of physical restraints for patients suffering from dementia.
This study reviews the ethical dilemmas of nursing staff about using restraints on patients suffering from dementia in two types of health care settings in Israel: internal medicine wards of three general hospitals; and psychogeriatric wards of three nursing homes. The nurses' level of knowledge about the Patient's Rights Law, the Israeli Code of Ethics, and the guidelines on restraints was analysed. The purposes of restraints were defined as beneficial to: (1) the patient; (2) other patients; or (3) the institution. The concept was evaluated in a realistic situation (expressing views of daily practice) and in an idealistic situation (expressing personal and professional beliefs and values). It was shown that nurses in internal medicine wards of general hospitals agreed more with the use of restraints than those in psychogeriatric wards in nursing homes. Differences were more pronounced when restraints were beneficial to the institution. In addition, nurses working in psychogeriatric wards of nursing homes had more knowledge about the guidelines on restraints and were less inclined than their counterparts to agree with the use of restraints for the benefit of other patients or the institution.
Accidental Falls↗
Understanding the reimbursement process.
Nurse practitioners must be fiscally responsible to obtain reimbursement for services provided. A thorough knowledge of the reimbursement process is required to accomplish this goal. This article explores the reimbursement process, generation of revenue, and personal productivity determination for nurse practitioners. Parameters for billing using the resource-based relative value scale, the Evaluation and Management Documentation Guidelines, the International Classification of Disease, and the Physicians' Current Procedural Terminology code book are explained.
Disease↗