Understanding Health Care Law

Health Care Law

• A collection of laws directly impacting health care delivery and relationships among providers and recipients.

Scope of Health Care Law

• Legislative actions involve introducing, changing, and repealing laws.
• Regulatory actions involve putting laws into effect through specific rules.
• Judicial decisions use previous court cases as supportive tools in legal matters.

Attributes of Health Care Law

• Rules are established by a government body or agency at the federal, provincial, or local level.
• Enforceable sanctions, like legal or regulatory penalties, exist for nurses or providers who violate professional standards, laws, or regulations.
• Information is publicly accessible.
• Consistent with provincial and federal laws.
• Authoritative action can modify, change, or uphold it.

The Fiduciary Relationship

• Involves a nurse's legal and ethical duty to act in the patient's best interest, prioritizing patient needs.
• This relationship is built on trust, integrity, and confidence.

Alberta Health Professions Act (HPA)

• A key law defining health professions in Alberta.
• It defines how to be a regulated professional
• It defines how regulatory bodies govern members
• Continuing competence is defined
• Sets standards of practice
• Defines restricted activities as within a nurse's scope if authorized and competent, otherwise outside.

CRNA: College of Registered Nurses in Alberta

• Regulatory body for RNs in Alberta.
• Mandate centers on ethical, safe, competent care by RNs, serving the public interest.
• Practice Standards describe expected RN behavior, regardless of role or setting.
• All registrants must understand and apply the Practice Standards.
• Practice Standards should be applied at all times, regardless of the domain, role, or setting
• It outlines the minimum expectations for registrants
• The minimum expectations for registrants will be measured by CRNA, the public, clients, employers, colleagues and themselve

CRNA Practice Standards

• Responsibility and Accountability
• Knowledge-Based Practice
• Ethical Practice
• Service to the Public

Scope of Practice

• Refers to RN knowledge and application to assist clients with health needs in various settings and situations throughout life.
• Interventions must be authorized, and nurses must be educated and competent to perform them.
• Scope of practice is determined by nurses and employers, guided by the HPA.

Self-Regulation

• Ensures safe, ethical, competent nursing practice.
• Includes accountability, public protection, professional knowledge, government oversight, and regulatory bodies.
• It is a privilege granted by the HPA with trust based regulating, educating, disciplining, and monitoring the nursing practice

Documentation

• Communication, continuity of care, and clinical judgment are reasons for documenting.
• It is vital for client safety and important to improve the quality of care.
• Documentation provides information for Funding, Legal, and Research purposes

Cases of violence

• Documentation is critical in cases of violence because it acts as a source of evidence in legal proceedings
• If the patient is physically assaulted, use direct quotes in documentation

Methods of Documentation

• Charting by exception is charting only when a finding is not normal- rarely used
• Narrative documentation follows a chronological, storied format.
• Problem-oriented SOAP charting includes subjective, objective, assessment, plan, intervention, and evaluation.

Guidelines for Quality Documentation

• Documentation should be factual and objective/subjective
• Documentation should be accurate with exact measures, correct spelling and with signatures.
• Documentation should be complete, including all assessments, measurements, and follow-ups.
• All documentation should be current and chronological
• All documentation should be organized and logical
• The documentation should be compliant with standards like CRNA and agency specifics

Purpose of Documentation

• Communicate to team members.
• Ensure continuity of care.
• Track outcomes.
• Prove that tasks were completed
• Provide evidence in court.
• Confirm suitable professional practice.

Types of Documentation

• Informal documentation consists of sticky notes, reports, doctor boards, and assignment sheets.
• Formal Documentation consists of databases, care plans, progress notes, flow sheets, checklists, handover notes, and risk assessments.

Informed Consent, Professional Identity, and Relational Practice

• The 5 C’s: Compassion, Curiosity, Commitment, Competence, and Corresponding

Professional Identity

• Is a sense of oneself as influenced by the nursing discipline's characteristics, norms, and values

Developing Professional Identity

• Requires hearing expectations clearly.
• Valuing debriefing and feedback from role models.
• Engaging in reflection.
• Actively adopting a professional identity.
• Understanding responsibilities for learning and accountability.
• Building relationships.
• Developing personal self-care habits and embracing patient experiences.

Exemplars for Professional Identity

• Integrity
• Compassion
• Courage
• Humility
• Advocacy
• Human flourishing

Relational Inquiry

• Allows a nurse to understand the patient context beyond the surface, including values, culture, emotions, relationships, and environment.

Relational Practice

• Conscious participation with clients through listening, questioning, empathy, mutuality, reciprocity, self-observation, reflection, and sensitivity.

Inquiry

• Is the approach or lens

Practice

• Is the actual work nurses do (actions, skills)

Informed Consent

• Includes the legal and ethical right to refuse with a clear understanding and the ability to withdraw consent at any time and can be formal or implied.
• B-Benefits, R-Risks, A-Alternatives, I-Information/Intuition, N-No

Implied Consent

• Is inferred from the patients actions

Expressed Consent

• Occurs when a patient directly and explicitly communicates their consent.

Ethics and Values

• Seven Values in the CNA Code of Ethics involves promoting safe, ethical, compassionate, and competent care with a promotion of health and well-being and it is important to promote and respect informed decision making with maintained privacy and confidentiality, justice with a promotion of being accountable while honoring dignity.

Ethical Approaches/Theories

• The Utilitarian approach relies on making decisions based on the consequences, taking into account the greatest good for the greatest number of people.
• The Deontological approach focuses on making decisions independent of the consequences, examining the rightness or wrongness of each situation.
• Healthcare primarily uses the Bioethics approach, obligation based, outcome oriented, and based on reason and is guided by the five principles.

Ethical Principles

• Autonomy
• Nonmaleficence ("do no harm")
• Beneficence ("do good")
• Justice
• Fidelity

Ethics

• The study of philosophical ideals of right and wrong behavior.

Value

• A strong personal belief or ideal.

Morals

• Personal principles as an individual.

Nursing Process

• A nonlinear, clinical reasoning tool involving assessment, diagnosis, planning, implementation, and evaluation.
• Assessment uses subjective, objective, biographical, and historical data, considering growth, development, and determinants of health
• It requires clustering data and identifying its relevance.

Nursing Priorities

• ABC/CAB, Maslow’s Hierarchy of Needs, Acute vs. Chronic, and Actual vs. Potential.

Nursing Hypotheses

• Focus on nursing problems, such as ineffective airway clearance or impaired urinary elimination; nurses cannot fix medical problems.

Nurse Analysis

• Starts with analyzing assessment data, such as high blood pressure

Nurse Planning

• Goals should be SMART: Specific, Measurable, Attainable, Realistic, Timebound

Implementation

• Independent nursing intervention should be collaborative, dependent, or interdependent.
• It is the heart of the care plan to improve patient health with clearly written, individualized, evidence-based rationale by performing and assessing interventions as well as documentation.

Evaluation

• Ask/observe if effective, document patient response, and adjust or discontinue goals/outcomes as needed
• Revisit the outcomes to ensure they are SMART, change interventions, and document/report.

Clinical Judgment

• Forming an interpretation or conclusion about a patient's needs, concerns, or health problems with a decision to act, modify approaches, or improvise.
• Clinical reasoning (the process) involves noticing, interpreting, and responding
• Critical thinking involves thinking with purpose to make thoughtful, evidence-based decisions.

Scope of Clinical Judgement

• Standards based approach (CRNA standards)
• Evidence-based practice
• Interpretivist perspective looks to understand the meaning behind someones experience

Attitudes and Criteria

• Holistic view of the patient situation
• Process orientation

Ways of Knowing - Nurse Metaparadigm

• Reasoning and interpretation with an ethical component
• Person, Health, Nursing, Environment being the nursing metaparadigm

Empirical Knowledge

• The science of nursing, accessible through physical senses, responding to “what is this” and “how does it work.”
• Scientific competence leads to scientific discovery.

Aesthetic Knowledge

• "The Art of Nursing," involving beauty, appreciation, seeing each client as unique, and moving beyond the surface.

Personal Knowledge

• Acceptance of self, grounded in confidence and self-knowledge, intuiting and treating individual clients, becoming self-aware, and being therapeutically present.

Ethical Knowledge

• Includes knowing right and wrong, standards, codes, and protecting client autonomy and rights.

Sociopolitical Knowing

• The interactions of persons and their environment along with nurses understanding of society and its politics.

Emancipatory Knowing

• Recognizing barriers to well-being and health, seeing the "big picture," and working to correct social injustices.

Critical Thinking

• The use of knowledge and reasoning to make accurate clinical judgements and decisions
• Involves the process and skills to recognize an issue and draw conclusions.

Medication Safety

• Medication errors involve ineffective treatment, rushing, using identical packaging, med given at the wrong time, lack of documentation, refusal of meds or a near miss.
• Rights to medication administration: Includes knowing and checking for the right medication, dose, patient, route, time, frequency, site, reason, documentation, education, technique, approach, assessment, evaluation, and the right to refuse.

Medication Routes

• PO (oral)
• SL -Sublingual
• Buccal
• Parenteral (IV, IM, SUBCUT, ID)
• Insertion
• Inhalation
• Intranasal
• Topical
• Transdermal
• Otic

Medication Forms

• Pills (tablets, capsules, enteric coated, sublingual, buccal)
• Liquids (suspensions, syrups)
• Creams, ointments
• Sprays
• Suppositories
• Patches
• Drops
• Injectable liquids

Writing Medication Orders

• Writing Medication Orders requires these Seven Essential Components:Pt full name, date/time written, med name, dosage, frequency/time, route, signature
• Interpreting a Med Order involves knowing name, dosage, route, and frequency.

Levels of Care in Canada

• Interpreting a medication order includes knowing the name, dosage, route, and frequency.

Health Care Settings

• Quaternary: Specially/certain areas & people- Provided at large university affliated hospitals
• Tertiary (Increasingly specialized/complex care) is for patients in hospital settings, may not be available in smaller hospitals
• Secondary: Specialized care, often requires referral from primary care provider
• Primary: Most offered, first point of contact- For most Canadians , widest scope, health promotion, disease prevention, and supportive health services the pt requires.

Health Care Definition

• Locations where patients seek or receive health care services. Attributes include institutional (hospitals, long-term, psychiatric facilities) and community-based settings.

Birth of Medicare

• By 1972, all Canadians had free access to hospital and medical care regardless of their ability to pay.-
• Challenges included rules that are not firm between provinces & federal transfer payments- provinces charged extra fees.
• This was a medical approach to health. People accessed health services only when ill.
• Canada Health Act (1984) identifies the objective of health care policy and establishes 5 pillars:Public administration, comprehensiveness, portability, universality, accessibility

Determinants of Health

• Include financial/social status, gender, health services, employment/working conditions, education/literacy, physical/social environments, personal health practices, and child development, with consideration of biology, genetics, culture, and indigenous status.

Primary Health Care

• A strong emphasis on health promotion and disease prevention.

Goal of Primary Healthcare

• Achieve better health for all.
• It can be achieved by addressing health equity issues, providing accessible and relevant health services, situating health intersectorally, collaborating for program and policy dialogue, and embedding patient/partner participation at all levels.

Principles of Primary Health Care

• Accessibility: Essential health services are available to all.
• Public Participation: Individuals and communities are active partners with decision making.
• Health Promotion: Process enables control over and improves health.
• Appropriate Technology: Methods are acceptable and affordable.
• Intersectoral Cooperation: Commitment from all sectors is essential.

Primary Health Care Priorities

• Teams - Access
• Info - Healthy living

Primary Health Care vs. Primary Care

• Primary Health Care is the foundation of Canada's healthcare with a focus on health promotion and disease prevention whereas Primary Care is a focus on individual healthcare with treatment and rehab with a 1:1 relationship.

Development

• Sequence of physical, psychosocial, and cognitive developmental changes occurring over the human lifespan.

Stages of Development

• Delayed
• Expected
• Advanced

Development Stages

• Infant (birth- 1 year)
• Toddler (1-3 years)
• Preschool (4-5 years)
• School Age (5-12 years)
• Teen (12-18 years)

Attributes and Criteria

• Criteria to assess developmental level, define developmental milestones, recognize developmental delays, identify developmental regression, and recognize developmental arrest.

Development Assesment

• An important step to assess changes in communication/language and psychosocial development, and assess abnormalities
• This will help to address health concerns and teach about improving risk at each stage in life

Piaget's Theory of Cognitive Development

• Focuses on intellectual organization, including how children think, reason, perceive, and make meaning.
• Stage 1: Sensorimotor (Birth-2yrs): Learn to repeat tasks and to grasp objects (Year 1), and object permanence develops (Year 2).
• Stage 2: Preoperational (2-7yrs): Shows egocentric ideas as well as parallel play.
• Stage 3: Concrete operations (7-11 yrs): Show Two perspectives, and learn about seriation with the ability to conserve
• Stage 4: Formal operations (11-adulthood): Shows the ability to think in abstract

Piaget's Theory of Moral Development

• Avoid punishment and obey authority during the Preconventional Level
• Actions are "right" when they serve one's own interests, with consideration for others during the Instrumental Relativist Orientation
• Seek the right things to do during the Conventional Level, by the Good boy/nice girl orientation

Erikson's Eight Stages of Psychosocial Development

• Trust vs. mistrust (infant-1): “Can I trust the world?”
• Autonomy vs. shame & doubt (1-3yrs):“Can I control my own behaviour?”
• Initiative vs. guilt (3-6yrs): “Can I become independent of my parents and explore my limits?”
• Industry vs. inferiority (6-11 yrs): “Can I master the skills necessary to survive & adapt?”
• Identity vs. role confusion (12-18 yrs): “Who am I?” “What are my beliefs, feelings, and attitudes?”
• Young Adult 18-40 : Intimacy vs. Isolation- Form close personal relationships in the youth, to be fully active in the community.

Nursing in Young Adults

• Primary, secondary, and tertiary prevention are roles of the nurse
• Monitor for unintentional injuries, suicide, and cancer which are the health risk factors

Nursing in Middle Adulthood

• Task includes to help people expand their social relationships
• Health can decline with age

The Nurse Role - Older Adults

• The older adult Integrity vs Despair
• Experience can change different body systems
• Structural and Physiological changes are normal, however symptoms such as disorentation are not normal

Geriatric Assessment

• Nurses use questionnaires and validated tools to assess
• Referrals (physician, OT, PT, etc.), education & anticipatory guidance, engage in goal setting, and targeted interventions

Care Coordination

• Deliberate organization of patient care activities between two or more participants is to facilitate the delivery of healthcare services
• Attributes includes:Patient-centered care , evidence-based care, efficiency, improved outcomes and value-based + team based

Family Dynamics

• It includes the interrelationships between individual family members the the forces at work within the family that produce particular behaviours or symptoms

Team-Based Care Coordination

• Interprofessional, team-based care (collaboration between nurses, OT, PT, etc.) Involves the Patient; family nurse; social workers; therapists; volunteers; etc.

Culture

• Involves the pattern of shared values attitudes beliefs that those who live in a common geographic region share with each other
• Requires effective teamwork, priority setting, delegation, clinical decisions, time management, and evaluation.
• Culture includes cultural awareness and cultural competence with cultural safety
• Cultural safety is where practitioners are self aware and culturally humble for the PT's community perspective recognizing trauma as well

Environmental Control

• Locus of Control is broken down into Internal (life events control is their control ) and External :Life with others

Stress Management Nursing

• Helps to identify stressors, evaluate coping mechanisms, observe for physical signs, and assess levels of support
• Provides stress management techniques, empathy, and referrals
• Ensure to make sure patient is centered and individually assessed

Caregiving

• Is an action or process of helping those who are suffering
• They have the ability to care, adapt, listen, show compassion, responsible and strong as advocates
• They serve as as advocates assist and mange ADL's and coordinate healthcare services
• Some commom stressors are:Change in relationship/arrangements, understanding, respite, conflict, unable to meet ones own self-needs

Family Dynamics

• interrelationships between and among individual family members or the forces at work within a family that produce particular behaviors or symptoms
• Familiy includes all those who say they are famiily

Palliative Care

• “Soothe” or “alleviate” the pain and suffering associated with serious diseases- with spiritual,emotional and mental support
• Nurses need to be aware off symptom relief by communication with pt

Grief and Loss Types

• Normal grief expected and significant loss , it is non linear with steps
• Anticipatory grief : Experiencing a mix of emotions when anticipating
• Complicated grief: Exaggerated
• Disenfrachised grief is described the experience of losing something of value

The Nurses role in Grief

• Nurses should communicate with the patient that may need help and what their loved ones wish for and how that should be honored

Nutrition

• It involves the right nutrition which includes:Oral intake, digestion, absorbtion and elimination. In general and depends from life span needs

Nursing Nutritional Assessment

• Assessment includes: Age Lifestyle Race and Genetics, as well as level for proper plan
• With emphasis on the assessment and the types, should have all levels of prevention

The need for Adequate Sleep

• Stage 1 and 2: important for very light sleep and allows the body to recover
• REM is important for muscle movements

The Sleep Schedule

• Infants :14-16 hours
• Toddlers:9-10
• School age 9-11
• Teens and Adults 7-9

Disorders of Sleep

• Primary SleepDisordes, secondary with medical conditions
• Disturbed/Agitated or hyper, food intake, disorientation or confusion are the main effects of sleep disturbances

The central part of human life

• It involves the the gender identity and roles of sexual orientation
• Influenced by the biology and cultures with family and peer groups and society
• Risk can include Adolescents, newly partners with disabilities from safe practices

Altered Reproduction

• Involves Education for adolescents for safe practices with a teritary