HIPAA: past, present and future implications for nurses

Congress enacted Health Insurance Portability and Accountability Act (HIPAA) in 1996 to limit the ability of an employer to deny health insurance coverage to employees with preexisting medical conditions. The law also directed the U.S. Department of Health and Human Services to develop privacy rules, including, but not limited to, the use of electronic medical records. This law has increased patient privacy, but in doing so has added to the financial burden, including personnel costs in health care. Nurses stand at the forefront in the resolution of the dilemma of patient privacy versus health care expediency. The purpose of this article is to assist nurses and other health care professionals to better understand their responsibilities regarding HIPAA regulations. First, responses to HIPAA regulations by covered entities to date, along with responses which are still needed, will be described. It will be noted that HIPAA is a work in progress and not a specific act. Next, future initiatives having HIPAA implications will be presented. In conclusion, the need for all covered entities and their personnel to look broadly at HIPAA as initiating a new way of work in health care will be emphasized.     

Complex, humanitarian emergencies: II. Medical liaison and training

In complex, humanitarian emergencies, professional liaison roles are just one of many that evolve from the coordination of United Nations agencies, the International Committee of the Red Cross, international and national non-governmental relief organizations, and coalition military forces. Liaison is crucial to the humanitarian relief process. Decision makers benefit from liaisons' professional experience, their knowledge of the characteristics, missions, and capabilities of each major participant in the relief process, and in their ability to coordinate and clarify professional issues in meeting the goals of a mission. Medical liaison roles develop from the awareness that complex emergencies primarily are catastrophic public-health emergencies. Unfortunately, education and training of the medical liaison currently are ill-defined. However, limited experience suggests that skills should be broadly based in principles of disaster epidemiology, assessment and management, knowledge of contributing relief resources, agencies and the military, and international humanitarian law and the Geneva Conventions.     

Operationalizing advanced practice registered nurse legislation: perspectives from a clinical nurse specialist task force

Many state boards of nursing are currently examining advanced nursing practice and determining a process to recognize and regulate it appropriately. In 1999, Minnesota state law was altered to define and provide title protection for advanced practice registered nurses. After passage of the new law, the Minnesota Board of Nursing convened 4 task forces, representing each of 4 advanced practice nursing groups, to develop recommendations regarding issues of certification, criteria for determining acceptable certifying organizations, procedures in the event of examination failure, and a process for communicating this information to the nursing community. This article provides an overview of the legislation and describes the process used to obtain and operationalize the new law. The process undertaken in the clinical nurse specialist task force is also described, including the key issues that emerged and lessons that were learned.     

La enfermera especialista en geriatría como respuesta clave en la atención a la persona mayor,la cronicidad,la cronicidad compleja y sus consecuencias en la dependencia

Aging together with multimorbidity, polymedication and various social factors are some of the determinants that lead to increasing complexity of care in the elderly, thus making it difficult for health systems to meet their needs.To approach this new and growing scenario of care for the elderly, the formal health and social care systems must define specific jobs for geriatric nursing specialists trained to address the needs of older people from a perspective of comprehensive care, both for healthy aging, and for the different health problems of this population group, characterized by the consequences of aging and chronicity, towards dependence, and develop the powers established by law in the framework of an interdisciplinary team, for those who have been trained and accredited, thus adding value to the response that health systems have to provide for this growing problem of the ‘aging-chronicity-dependence’ triad.     

New Mexico safety restraint law: changing patterns of motor vehicle injury, severity, and cost

The impact of the New Mexico safety belt law on patterns of injury, severity, and cost was evaluated (using an emergency department data base). Data collected from November 1985 through February 1986 compared the 2 months before the January 1986 law with 2 months after. Before the law, 22.2% of the 379 injuries included abrasions, contusions, and lacerations to face, neck, and head. Following the law, this category constituted only 13.8% of 356 injuries, representing a reduction of 38% (P less than .05). Cost and injury severity scores (ISS) for 436 injured patients covered by the law were not significantly different between the pre- and post-seatbelt law periods. However, significant cost and severity differences were observed after the law between belted and nonbelted occupants: +2,569 compared with +662; ISS of 3.6 compared with 2.0 (P less than .05). Methodologic problems of an emergency department-based study and the need for E coding (external causes of injury) are discussed.     

Regulations, standards, and guidelines

Standards appearing in the Federal Register are law and are mandatory. Voluntary guidelines only constrain an institution if the guidelines are incorporated into the hospital's rules. Hospitals are required to have rules and regulations; however, they apply only to each individual hospital.     

Guidelines in respect of advance directives: the position in England

The fundamental aim of the advance directive is to provide a means for the patient to continue to exercise autonomy and shape the end of his/her life. The principle is not new. Patients who are aware of approaching death have for many years discussed with their health-care team how they wish to be treated. The advance directive registers these views in a more formal way. However, inconsistencies persist in the understanding of the legal issues around advance directives in the UK, and suggest that national guidelines would encourage National Health Service trusts to develop local policies to improve understanding and compliance with the law. This article draws on English law to address misunderstandings and proposes which information advance directives should include.     

The SGB IX,book 9 of the German social code,in the development of social security law

The SGB IX is the legal basis of rehabilitation in Germany since 2001. It is embedded in the codification of the German social code, the Sozialgesetzbuch (SGB). There it has an intermediate function between the general social law and the special laws of the social insurance and social security institutions. Rehabilitation in Germany is working in a system of several different institutions with different legal roots. In special these are compensation of damages caused by employment accident and war and the avoidance of disability benefits by rehabilitation and activation. Inequality of treatment of disabled people according to the cause of their disability and to their employment status are accepted less; common principles of rehabilitation are being searched. Important reforms of rehabilitation law have taken place in 1974 and 1975. Since then problems have become visible in implementation and in the coordination of the complex system. SGB IX is a new effort for a general rehabilitation law. Open questions remain in handling the relations between rehabilitation and sickness treatment, long term care and prevention. Important are the newly defined terms for participation (Teilhabe) and disability (Behinderung), which build the linkage of SGB IX with constitutional law and with the health sciences. A weak point is still the relation of disability and age. Political attempts for unequal benefits in health insurance endanger the now reached level of rehabilitation law.     

Models, measurement, and strategies in developing critical-thinking skills

Health care professionals must use critical-thinking skills to solve increasingly complex problems. Educators need to help nurses develop their critical-thinking skills to maintain and enhance their competence. This article reviews various models of critical thinking, as well as methods used to evaluate critical thinking. Specific educational strategies to develop nurses' critical-thinking skills are discussed. Additional research studies are needed to determine how the process of nursing practice can nurture and develop critical-thinking skills, and which strategies are most effective in developing and evaluating critical thinking.     

Occupational health nursing practice, education, and research in Korea. An international update.

1. In Korea, occupational health nurses have been working as health managers at the workplace and as part of a hospital based group occupational health service since 1991. The role of occupational health manager, required by law, includes providing preventive and primary care, safety management, and inspection of the work environment. 2. Recently, occupational health nursing practice-based lecture has increased, and more emphasis has been placed on the process of occupational health nursing in both undergraduate and graduate programs. 3. The Korean Association of Occupational Health Nurses and the Korean Academic Society of Occupational Health Nursing have been working to develop professional competence for occupational health nurses since 1991. 4. Until the mid 1990s, occupational health nursing research focused primarily on role and job satisfaction of occupational health nurses. However, the number of research studies has dramatically increased and, gradually, survey studies have been replaced by studies with experimental design.     

To the marriage of true minds: Some synergisms of ethics, law, and medicine

Ethics and law have influenced the practice and the teaching of medicine. This paper traces some of that influence by examining the concepts of paternalism and privacy. Some surprising ways that philosophy has affected medicine are also detailed. What is finally revealed is the value-laden nature of medicine, ethics, and law.     

Worry, Optimism, and Expectations as Predictors of Anxiety and Performance in the First Year of Law School

Research suggests that worry, optimism, and expectations have subsequent effects on performance, which may be mediated through self-efficacy expectations. The first year of law school provides a unique naturalistic setting in which to study this process. Participants were recruited at orientation and assessed at five points during their first year of law school. Results indicated that worry was significantly related to self-efficacy and anxiety. Controlling for trait anxiety, higher levels of worry were also predictive of better academic performance. Expectations were positively related to class rank and performance on a final exam, and predicted first year law school grade-point average (GPA) even after controlling for undergraduate GPA and Law School Admissions Test score. Optimism was inversely related to both dispositional and state anxiety, although it was not related to performance. Implications of these findings for counseling first-year law students are discussed, and the results may generalize to other professional situations.     

护理收费现状引发的思考

护理劳动收费价格制定标准执行数年没有变更 ,造成护理工作高成本支出与低收费的矛盾及“重医轻护”与护理工作重要性的矛盾。护理经济管理应与时俱进 ,遵循市场规律 ,才能取得迅速发展     

To the marriage of true minds: Some synergisms of ethics,law, and medicine

Abstract

Ethics and law have influenced the practice and the teaching of medicine. This paper traces some of that influence by examining the concepts of paternalism and privacy. Some surprising ways that philosophy has affected medicine are also detailed. What is finally revealed is the value-laden nature of medicine, ethics, and law.     

Life care plans: an emerging area for occupational therapists

BACKGROUND: Life care plans, or cost of future care reports as they are often called in Canada, are medico-legal documents that predict probable future medical and rehabilitation needs and costs. They are used when someone has sustained a serious personal injury in an accident, as the result of medical malpractice, or due to some other unnatural cause. Life care plans are generally commissioned by third-party payers in order to set aside adequate reserves for future costs or to negotiate a settlement. SCOPE: Life care plans need to be grounded in knowledge of how personal injury law has been applied and interpreted. Therefore, Canadian law pertaining to the costs of future care in personal injury will be briefly reviewed. The balance of the article discusses the process used to develop a life care plan, the necessary content, and accepted formats for reports. The article concludes with a case example that demonstrates the application of life care planning skills. PRACTICE IMPLICATIONS: Occupational therapists are well suited to developing these plans by virtue of their training, knowledge base, and theoretical approaches. This is an emerging consultative role for experienced therapists.     

Investigation, science, and research partner to solve elderly woman's shocking homicide

As the investigation and prosecution of sexual homicide cases becomes increasing complex, law enforcement agencies are utilizing alternative avenues of investigative assistance. In 2004, the Oakland County, Michigan Sheriff's Office was faced with the horrific sexual assault and murder of an elderly woman. Although familiar with violent crime, this extremely violent and unusual case motivated the police to enlist the help of forensic scientists and FBI violent crime researchers to assist their investigation. This partnership led to the successful investigation and prosecution of the offender and serves as a model for law enforcement agencies willing to consider using additional available resources in order to successfully resolve unusual and extraordinarily violent sexual crimes.     

Quantitative ultraviolet, visible, and near infrared spectrophotometric analysis

The potentialities of photometry in the ultraviolet, visible, and infrared spectra are compared. Errors associated with neglect of the Booger-Lambert-Ber law, nonmonochromic light, inconstant length of optic route, and non-optimal choice of optic density range are analyzed.     

Wilderness emergency medical services systems

Wilderness emergency medical services (WEMS) systems have components and requirements that are different from those of traditional EMS systems. These differences arise from the extremes of time and environmental exposure and the limited available resources that help define the wilderness environment. Although disaster systems combine wilderness and traditional EMS system components, most WEMS systems have had to develop independently on a localized level and in response to the need of a particular community or location. In many cases, volunteers provide much of the personnel and resources available to law enforcement agencies that are ultimately tasked with the responsibility of oversight for effecting rescues in a wilderness setting.     

The treatment of sex offenders: evidence, ethics, and human rights

Public policy is necessarily a political process with the law and order issue high on the political agenda. Consequently, working with sex offenders is fraught with legal and ethical minefields, including the mandate that community protection automatically outweighs offender rights. In addressing community protection, contemporary sex offender treatment is based on management rather than rehabilitation. We argue that treatment-as-management violates offender rights because it is ineffective and unethical. The suggested alternative is to deliver treatment-as-rehabilitation underpinned by international human rights law and universal professional ethics. An effective and ethical community-offender balance is more likely when sex offenders are treated with respect and dignity that, as human beings, they have a right to claim.     

An interdisciplinary mock trial involving pharmacy, law, and ethics.

OBJECTIVE: To describe an innovative, interdisciplinary approach to illustrate the relationship between healthcare ethics and law. METHODS: A mock trial was created for students enrolled in the Samford University McWhorter School of Pharmacy and Department of Paralegal Education. The trial served as the starting point to discuss confidentiality in health care in general and pharmacy in particular. Students from both programs served on the jury and rendered a verdict after the case had been presented. The Alabama statute concerning exceptions to confidentiality is reviewed. The students' assignment and lessons learned are also described. SUMMARY: Students thoroughly enjoyed this method of teaching and learning. The mock trial provided an interesting way to exemplify the often complex relationship between healthcare ethics and law.