ANCC® ADULT-GERONTOLOGY ACUTE CARE NURSE PRACTITIONER AGACNP EXAM REVIEW DEFINITION OF KEY WORDS

ANCC® ADULT -GERONTOLOGY ACUTE CARE NURSE PRACTITIONER AGACNP EXAM REVIEW DEFINITION OF KEY WORDS Scope of Practice - Based on legal allowances in each state, individual state nurse practice acts providing guidelines for nursing practice Key elements of the NP role include - integration of care across the acute illness continuum with collaboration and coordination of care; research based clinical practices, clinical leadership, family assessment, and discharge planning Standards of Advanc ed Practice are delineated by... - American Nurses Association which measure quality of practice, service, or education State Practice Acts - Authorize Boards of Nursing in each state to establish statutory authority for licensure of RNs State Practice A cts - authority includes: - use of title, authorization for scope of practice including prescriptive authority, and disciplinary grounds States vary in practice requirements, such as - certification Prescriptive authority - Ability and extent of NPs abil ity to prescribe meds DEA has ruled that nurses in advanced practice may obtain.. - registration numbers, state practice acts dictate level of prescriptive authority allowed Credentials encompass... - required education, licensure and certification to pr actice as an NP Credentials establish... - minimal levels of acceptable performance Credentialing is necessary to: - ensure that safe healthcare is provided by qualified individuals; comply with federal and state laws r/t APN Credentials also... - ackno wledges the scope of practice of NP, mandates accountability, enforces professional standards for practice Licensure - establishes that a person is qualified to perform in a particular professional role Licensure is granted as defined by rules and regula tions set forth by - a governmental regulatory body (ie. state board of nursing) Certification - Person has met certain standards that signify mastery of specialized knowledge Certification is granted by nongovernmental agencies such as - ANCC, AANP Admitting privileges to hospitals (non physican) were granted - 1983 by JC Credentialing and privileging - process which an NP is granted permission to practice in an inpt setting Credentialing with hospital privileges is granted by a - Hospital Credenti aling Committee Pt Medical Abandoment - When caregiver -pt relationship is terminated w/o making reasonable arrangements w an appropriate person so that care can be continued Determination of pt abandonment depends on factors such as: - Whether NP accepte d pt assignment, whether NP provided reasonable notice before termination, whether reasonable arrangements could have been made Following do not constitute pt abandonment - NP refuses to accept responsibility for pt assignment when NP has given reasonable notice to proper authority that NP lacks competence to carry out assignment; NP refuses assignment of a double shift or addtl hrs beyond posted work schedule when proper notification has been given..latter phrase can be controversial Risk Mgmt - Systemat ic effort to reduce risk begins w formal written risk mgmt plan that includes: organizations goals, delineation of program's scope, components, methods; delegating responsibility for implementation and enforcement; demonstrating commitment by the board; co nfidentiality and immunity from retaliation for those who report sensitive info Most common method of documentation for risk mgmt - incident reports Policies regarding incident reports should address: - ppl authorized to complete report; ppl responsible for review of a report, immediate actions needed to minimize the effects of the event; ppl responsible for follow up; plan for monitoring aftermath; security/storage of completed report Risk mgmt - Satisfaction surveys - Important for identifying problems before they develop into incidents or claims; for pts and employees Risk mgmt - Complaints: Risk mgmt plan should delineate tracking, analyzing, and managing complaints by clearly identifying: - ppl notified after receiving complaint; ppl responsible for responding; ppl responsible for monitoring follow up Action taking initiatives: - Prevention, correction (corrective steps must be monitored and audited), documentation, education, departmental coordination Medical Futility - Interventions that are unlikely to produce significant benefit for pt - "Does the intervention have any reasonable prospect of helping this pt?" Two kind of medical futility: - Quantitative futility: likelihood that intervention will be nefit pt is extremely poor Qualitative futility: quality of benefit an intervention will produce is extremely poor Informed consent - competence (decisional capability) - state that pt is able to make personal decisions about their care competence implie s that ability to: - understand, reason, differentiate good and bad, and communicate informed consent - pt has received adequate instruction or info regarding aspects of care to make prudent, personal choice regarding such tx Informed consent includes: - discussing benefits and risk consent is assumed if... - pt's condition is life threatening Danforth Amendment 1991 - pts are informed at time of admission to federally funded institution (such as hospital, nursing home, hospice, HMO, etc) that they have the right to refuse care as long as the pt has decisional capability (competence) Ethics - study of moral conduct and behavior protecting the rights of an individual 1st priority is the - most salvagable pts. Most critically injured cared for last. Key ethical principles are: - nonmaleficence, utilitarianism, beneficence, justice, fidelity, veracity, autonomy Nonmaleficence - duty to do no harm Utilitarianism - the right act is the one that produces the greatest good for the greatest number Beneficen ce - duty to prevent harm and promote good Justice - duty to be fair Fidelity - duty to be faithful Veracity - duty to be truthful (tends to be in conflict with fidelity) Autonomy - duty to respect an individual's thoughts and actions (tend to be in conflict with beneficence) Dismissing/discharging a pt or closing practice - NP cannot withdraw from caring for a pt without notification Examples of reasons for discharging a pt from practice: - abuse, refusal to pay, persistent non -adherence to care Steps for discharging a pt from practice: - send a certified letter with return receipt (copy for chart), provide general healthcare coverage for 1st 15 -30 days post termination deadline, obtain release of info to provide copies of all needed records for next care provider Obligations in closing practice d/t relocation, retirement - give pt adequate time to find another provider, keep all files for min 5 years, provide timely not ification and names of other providers and resources for future care Role of NP developed in the early... - 1960s as a result of physician shortages in the area of peds First NP program was peds, begun in... - 1964 by Dr. Loretta Ford and Dr. Henry Silve r at CU Health Sciences mainly focusing on ambulatory and outpt care Historical service of NPs in primary care resulted in part from the... - availability of federal funding for preventive and primary care NP education Movement of NPs expanded to the... - inpt setting as a result of managed care, hospital restructuring, and decreases in medical residency programs 4 distinct roles for NPs: - clinician, consultant/collaborator, educator, researcher Crisis/Acute Grief Communication - Acknowledge feelings Offer self Crisis Intervention - Boundaries Security if necessary, NOT police Establish trust/rapport Advance Directive - Written statement of patient's intent regarding medical treatment