Nursing Practice Standards and Regulations

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Questions and Answers

What determines the scope of practice for Nurse Practitioners (NPs)?

National Nursing Association guidelines

Professional Nursing certifications

Federal regulations

State legislative statutes (correct)

Which organization determines the standard of practice for nursing?

American Nurses Association (correct)

National Institute of Health

American Medical Association

State Board of Nursing

Under the Medical Record Confidentiality Act, what must a provider obtain to release a patient’s medical information?

Written authorization and consent (correct)

A court order

Verbal agreement from family members

Oral permission from the patient

In which scenario is confidentiality not upheld according to exceptions outlined in the content?

When the client reveals an intent to harm themselves Signup and view all the answers

Which of the following is an example of when a nurse might have to disclose confidential information?

Mandatory reporting of a communicable disease Signup and view all the answers

What is the primary obligation of a provider under the Tarasoff Principle?

To warn potential victims of imminent danger from a client Signup and view all the answers

Which component does NOT belong to the elements of informed consent?

Family Member Consent Signup and view all the answers

What does the ethical principle of justice ensure in healthcare?

Care must be provided equally, regardless of social or financial status. Signup and view all the answers

What is the definition of 'Competency' in the context of informed consent?

A legal determination of a client's ability to make reasonable judgments Signup and view all the answers

Under what condition can surrogate decision-makers act on behalf of patients?

When patients lack the capacity to make decisions themselves Signup and view all the answers

What does nonmaleficence in ethics specifically refer to?

Doing no harm to patients Signup and view all the answers

Which ethical principle emphasizes telling the truth to patients?

Veracity Signup and view all the answers

What does voluntariness refer to in the context of informed consent?

Patients should provide consent without feeling pressured or coerced. Signup and view all the answers

Under Level of Evidence criteria, which type of evidence is classified as Level I?

Evidence from a systematic review or meta-analysis of RCTs Signup and view all the answers

Which of the following accurately defines autonomy in healthcare ethics?

Patients should have the freedom to make their own healthcare decisions. Signup and view all the answers

Study Notes

Scope of Practice

Determined by state legislative statues (State BON)
Defines NP roles and actions
Identifies competencies assumed to be held by all NPs who function in a particular role.
Varies broadly from state to state.

Standard of Practice

Determined by ANA (American Nurses Association)
Authoritative statements regarding the quality and type of practice that should be provided.
Provide a way to judge the nature of care provided.
Can be used to legally describe the standard of care that must be met by a provider.
May be precise protocols or more general guidelines.

Confidentiality

Client’s right to assume that info given to provider will not be disclosed.
Protected under the Medical Record Confidentiality Act of 1995 (S. 1360).
Requires provider to obtain signed medical authorization and consent forms to release medical records and info when requested by the family member or another healthcare provider.
HIPAA does not allow the PMHNP to make most disclosures about psychotherapy notes for a patient’s condition without their authorization.
Two separate releases of information are required to release information on patient’s chemical and psychiatric care to a third party.

Exceptions to Confidentiality

When appropriate persons or organizations determine that the need for information outweighs the principle of confidentiality.
If a client reveals an intent to harm self or others.
Information given to attorneys involved in litigation.
Releasing records to insurance companies.
Answering court orders, subpoenas, or summonses.
Meeting state requirement for mandatory reporting of disease conditions (Medical conditions).
Cases of child or elder abuse.

Tarasoff Principle

Tarasoff v Regents at University of California, 1976
Duty to warn potential victim of imminent danger of homicidal client.

Communication process between provider and client that results in client’s acceptance or rejection of proposed treatment.
An explanation of relevant information that enables the client to make an appropriate and informed decision.
The right of all competent adults or emancipated minors.
Emancipated minors are persons younger than 18 years old who are married, parents, or self-sufficiently living away from the family domicile.

Decisional Capacity (Competency) - patients should have the capacity (or ability) to make the decision.
Competency is a legal, not medical concept; determination that a client can make reasonable judgments and decisions regarding treatment and other health concerns.
Full Disclosure - the provider should disclose information on the treatment, test, or procedure in question, including the expected benefits and risks, and the likelihood (or probability) that the benefits and risks will occur.
Comprehension - the patient should be able to comprehend the relevant information.
Voluntariness - the patient should voluntarily grant consent, without coercion.
Documentation - provider must document in medical record that informed consent has been obtained from the client.
If patients are not able to do all of the above components, family members, court-appointed guardians, or others (as determined by state law) may act as “surrogate decision-makers” and make decisions for them.

Ethical Principles

Justice - doing what is fair, fairness in all aspects of care.
Justice leads us to ensure that care is provided on a fair and equal basis, regardless of patients’ social or financial status, sexual orientation, or ethnicity.
Nonmaleficence - doing no harm.
Imminent danger example: Stopping a medication that is causing harmful side effects or discontinuing a treatment strategy that is not effective and may be harmful.
Beneficence - promoting well-being and doing good.
Fidelity - being true and loyal.
Veracity - telling the truth.
Patients need to know the truth about their medical conditions and treatment options.
Autonomy - doing for self.
Right to self-determinations.
Allows healthcare teams to respect and support a patient’s decision to accept or refuse life-sustaining treatments.
Respect - treating everyone with equal respect.

Key differences between Veracity and Fidelity

Veracity focuses on honest communication.
Fidelity focuses on loyalty and commitment to promises.

Level of Evidence (LOE)

Level I: Evidence from a systematic review or meta-analysis of all relevant RCTs or evidence-based clinical practice guidelines based on systematic reviews of RCTs or three or more RCTs of good quality that have similar results.
Level II: Evidence obtained from at least one well-designed RCT.
Level III: Evidence obtained from well-designed controlled trials without randomization.
Level IV: Evidence from well-designed case-control or cohort studies.
Level V: Evidence from systematic reviews of descriptive or qualitative studies.
Level VI: Evidence from single descriptive or qualitative studies.
Level VII: Evidence from expert opinion or consensus from authorities in the field.

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Description

This quiz covers essential concepts related to the scope of practice, standards of practice, and confidentiality in nursing. You'll explore how state laws and the ANA guidelines shape nursing roles and responsibilities, as well as the importance of client confidentiality in healthcare. Test your knowledge on these critical areas of nursing practice.