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PubMed1993

[Development of ICN's Code of Ethics].

Development of the ICN Code for Nurses (Ethical Concepts Applied to Nursing) was explored from the Finnish perspective. The article was mainly based on the archival sources of the Finnish Federation of Nurses and on the ICN publications. The 1953, 1965 and 1973 Codes were briefly discussed. It was observed that the Federation never explicitly integrated the Code for Nurses into its decision-making.

Ethics, Nursing↗
PubMed2005

The significance of cognitive modeling in building healthcare interfaces.

BACKGROUND: Although there are many reasons that widespread adoption of healthcare information systems has not transpired, one reason is a failure to take into account the cognitive needs of the users. AIM: To understand the cognitive needs of nurses and physicians and determine how these needs should influence the design of healthcare interfaces. DESIGN OF STUDY: A qualitative and quantitative study that compares how nurses and physicians comprehend patient information. SETTING: Twenty-four registered nurses and twenty-four physicians working in the specialties of gastrointestinal or internal medicine. METHODS: Each clinician reviewed two mock electronic medical records and summarized the cases using a think-aloud protocol. All verbalizations were coded for medical and conceptual information. RESULTS: The nurses included a larger mean proportion (p<0.001) of recalls than did the physicians. As compared to the nurses, the physicians included a statistically significant (p<0.001) larger mean proportion of inferences, conditional statements, and interventions. The nurses concentrated on functional problems, whereas the physicians focused on diagnosis, treatment, and management. CONCLUSION: The main cognitive differences between the physicians and the nurses are explained through the differences in their practice models. Therefore, healthcare IT must develop separate interfaces for each discipline to address their unique needs.

Adult↗
PubMed2006

Intimate partner violence against women: findings from one state's ED surveillance system.

INTRODUCTION: Victims of intimate partner violence against women (IPVAW) often come into contact with various health care professionals, including emergency nurses. Michigan has implemented an ED surveillance system to monitor IPVAW in the state. METHODS: Twenty-three emergency departments participate in the Michigan Intimate Partner Violence Surveillance System. Female assault and maltreatment victims are identified using International Classification of Diseases Clinical Modification (ICD-9-CM) diagnostic and E codes (External Cause of Injury/Adverse Effects codes). For a 2-year period (1999-2000), patients' charts were reviewed, usually by an emergency nurse, to identify IPVAW victims. RESULTS: A total of 3111 female assault and maltreatment victims were identified. Of the 2926 incidents for which physical and/or sexual violence was confirmed by chart review, 1136 (38.8% [95% confidence interval: 37.1% to 40.6%]) involved IPVAW. DISCUSSION: A hospital ED surveillance system revealed that more than a third of female assault and maltreatment incidents were attributable to intimate partner violence, with a considerable proportion being young women abused by an ex-boyfriend. Surveillance also identified a need for improved documentation of female assault and maltreatment in ED records. We realized the benefits of using a public health surveillance process to monitor IPVAW incidence, identify high-risk groups, and reduce research costs.

Adolescent↗
PubMed1996

Is the professional code still the cornerstone of clinical nursing practice?

Although codes of practice for those concerned with the health care of others have always been inherent in the structure of societies, they have been institutionalized within the nursing discipline since the end of the last century. Up until the early 1970s they promulgated subservience to the medical discipline. As a result of the processes of emancipation and professionalization, the philosophy of the nurse has come to contain concepts of autonomy, accountability and patient-advocacy, based on a personal and individualized care system. Research in recent years has shown that nurses are making morally sound and ethically acceptable choices based on their own decision-making abilities, whilst having little or no active knowledge of the existing professional codes. Based on the literature, the author discusses ethical codes in relation to their perception by nurses in the clinical situation. The influence of the code in the areas of moral decision making, administration and management, and education are likewise discussed and the conclusion is reached that codes remain the cornerstone of nursing practice.

Attitude of Health Personnel↗
PubMedDate not supplied

Enhancing ethical thinking: the role of a national nurses' association.

Values are imbedded in our cultural background and environment. Yet each generation must rethink and reshape ethics in relation to the values of its own time. This is particularly true for healthcare professionals. National nurses' associations owe it to their members to keep them informed about ethical issues and to provide guidance. To be released by ICN at end-April, "Ethics in Nursing Practice" gives a detailed guide to ethical decision making (see advertisement on inside back cover). Below, how Swiss nurses are tackling the ethical issues.

Codes of Ethics↗
PubMed1994

Assessment of methods and outcomes: using modified inpatient ciprofloxacin criteria in community-based drug use evaluation.

OBJECTIVE: To determine if published drug use evaluation (DUE) criteria for inpatients could be modified to describe and evaluate drug therapy in outpatients. DESIGN: Retrospective review of drug profiles and diagnostic codes in outpatients included in the Iowa Medicaid Management Information System database. METHODS: Criteria specifying clinical indication, process indicators, complications, and outcomes were modified from existing inpatient DUE criteria for ciprofloxacin. The Iowa Medicaid database provided demographics, drug profiles, and diagnostic codes for outpatients prescribed ciprofloxacin between March 1 and March 15, 1993. RESULTS: 539 patients were evaluated. Mean (+/- SD) age was 62.1 +/- 23.8 years; 70.9 percent were women, 44.9 percent were nursing home patients who received lower doses (p = 0.04). Of 146 patients (27.1 percent) with infection-related International Classification of Diseases-Clinical Modification, 9th Revision (ICD-9CM) codes, 43.8 percent did not meet indication for use criteria, 15.8 percent met criteria, and 40.4 percent were equivocal/other. Process indicators in 539 patients revealed that 2.4 percent were < 18 years old and potential interactions existed for theophylline (9.3 percent), iron (9.7 percent), warfarin (4.8 percent), sucralfate (2.2 percent). Two patients (0.4 percent) received prenatal vitamins. Dosage and duration of therapy could not be linked to disease severity. Complications of therapy were not evaluable. Outcomes were assessed indirectly by using concurrent antibiotic histories. These histories showed that patients received a mean 2.7 +/- 2.4 (median 2, range 1-16) ciprofloxacin prescriptions during the study period. There was frequent concurrent use of antibiotics, and 29 percent of prescriptions were preceded or followed by additional quinolone therapy within 30 days. CONCLUSIONS: Evaluating appropriateness of therapy with this methodology is feasible if validated ICD-9CM codes are reported consistently in sufficient numbers of patients. Low levels of reporting of relevant disease codes require that large numbers of patients be screened to use this method effectively. Descriptive use data are readily obtained. Data obtained by this method indicated several apparent deficiencies in ciprofloxacin therapy.

Adolescent↗
PubMed1997

[Ethics in nursing].

The conclusion reached at the end of this article is that there is a crisis in the ethics of nursing and that the focus of the ethics of nursing should be on virtues. The reconstruction of a virtue-based ethics in nursing is proposed as a solution for the current crisis in the ethics of nursing. With an analysis conducted on the ethics of nursing the story is told of an individual nurse within nursing in the South African society. Certain concepts to ethics as well as the dimensions of ethics in nursing are explained within the narrative of nursing. The institutionalisation of ethics of nursing is described based on the three ethical traditions that moved from virtues, to responsibility to human rights. An analysis of the moral practice in nursing indicates that a crisis in the ethics of nursing exist within the last tradition of human rights because of the conflict between the rights of the nurse and the patient. Through the analysis it becomes clear that no rules, codes or law can ensure moral behaviour. The control over moral behaviour should rather be internal than external. If a person does not have the virtues he or she does not understands the rules and human rights and responsibilities have a different meaning for them.

Attitude of Health Personnel↗
PubMed1994

The IRS looks closely at homes for the aging. Organizations must be prepared to face increased scrutiny on tax-exempt status and financing.

Tax-exempt status has long been perceived as appropriate for the traditional retirement home (i.e., congregate housing and life-care facility), which serves the elderly and typically experiences low profit margins. An organization that is both organized and operated exclusively for religious, charitable, scientific, literary, or educational purposes or for testing for public safety may qualify for tax-exempt status under Internal Revenue Code section 501(c)(3). The Internal Revenue Service uses the generic term "homes for the aging" to include all forms of retirement housing facilities (except nursing homes that solely provide the highest level of nursing care). A home for the aging that qualifies under section 501(c)(3) (through satisfaction of the organizational and operational tests) will qualify for charitable status for federal tax purposes if it operates to satisfy the following basic needs of aged persons: suitable housing, healthcare, and financial security. In general, not-for-profit organizations recognized as exempt under code section 501(c)(3) may be eligible for tax-exempt financing to develop a home for the aging through the issuance of tax-exempt bonds. Effective tax-exemption planning is a necessary part of the business planning process by sophisticated not-for-profit organizations that own and operate (or desire to own and operate) charitable homes for the aging and similar housing facilities serving the elderly. The benefits of exempt status remain attractive for many such organizations. The challenge of obtaining and maintaining that status is becoming far more burdensome.

Aged↗
PubMedDate not supplied

Human rights: implications for patients and staff.

Originating from wider declarations of fundamental human rights, individual human rights in the field of health care, also called patients' rights, have been elaborated, developed and implemented by most international organisations, including the European Union and the World Health Organisation. The Council of Europe is however, particularly prominent in its work in the field of human rights, having drawn up a number of vital international treaties, among them and most importantly the Convention on Human Rights and Biomedicine, which strengthens internationally the legal position of the patient and the research subject in setting a minimum level of protection in respect of individual human rights and health and is binding upon the member states that have ratified it. Nonetheless, it needs to be examined to see if the European Union would be a better alternative to regulate these patients' rights.

Codes of Ethics↗
PubMedDate not supplied

Understanding the scientific issues embedded in the generic drug approval process.

OBJECTIVE: To review the major scientific issues embedded in the generic drug approval process. DATA SOURCES: Articles indexed initially under terms such as generic medications, generic drugs, bioequivalence, and bioinequivalence. These terms were used to search indexing services such as MEDLINE, International Pharmaceutical Abstracts, CINAHL (a database of nursing and allied health literature), and Science Citation Index. Additional data sources included the Code of Federal Regulations and regulatory guidances from the Food and Drug Administration (FDA) Center for Drug Evaluation and Research. STUDY SELECTION: Performed by the authors. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: Despite the fact that regulations regarding bioequivalence have been in place for more than 20 years, controversies over bioequivalence continue to arise. Consensus on many of these issues is driving the development of new FDA guidances regarding bioequivalence. Still, despite the issuance of new guidance and consensus building among scientists, many clinicians and consumers remain uninformed regarding the scientific basis for establishing bioequivalence and the generic drug approval process in general. Although some have suggested that the generic drug approval process is flawed, overall, it appears that the process works. CONCLUSION: Understanding the generic drug approval process and the issues surrounding bioequivalence is of paramount importance to both clinicians and scientists.

Drug Approval↗
PubMed1995

Electroconvulsive therapy, children and adolescents: the power to stop.

The administration of electroconvulsive therapy (ECT) to children and adolescents remains an unresolved area of clinical debate for nurses. Thus, some nurses have refused to participate in the treatment of minors with ECT, invoking codes of conduct to justify their actions. Other nurses have supported the use of ECT with children and adolescents, via provision of technical assistance to medical colleagues. A cross-national comparison of ethical codes of conduct has confirmed that nurses should take decisive action in the clinical arena when the needs or rights of vulnerable minors are compromised. The provision of clinical guidelines is suggested as one method to enshrine the rights of at-risk children and adolescents.

Adolescent↗