AMA Resolution Opposes Independent Practice by APRNs.

An old debate heats up again.

The effectiveness of sexual assault nurse examiner (SANE) programs: a review of psychological, medical, legal, and community outcomes.

In sexual assault nurse examiner (SANE) programs, specially trained forensic nurses provide 24-hour-a-day, first-response medical care and crisis intervention to rape survivors in either hospitals or clinic settings. This article reviews the empirical literature regarding the effectiveness of SANE programs in five domains:(a) promoting the psychological recovery of survivors, (b) providing comprehensive and consistent post-rape medical care (e.g., emergency contraception, sexually transmitted disease [STD] prophylaxis), (c) documenting the forensic evidence of the crime completely and accurately, (d) improving the prosecution of sexual assault cases by providing better forensics and expert testimony, and (e) creating community change by bringing multiple service providers together to provide comprehensive care to rape survivors. Preliminary evidence suggests that SANE programs are effective in all domains, but such conclusions are tentative because most published studies have not included adequate methodological controls to rigorously test the effectiveness of SANE programs. Implications for practice and future research are discussed.

A inserção da enfermeira no atendimento pré-hospitalar: histórico e perspectivas atuais / Nurse integration into pre-hospital medical services: historical outline and current perspectives

Estudo bibliográfico de caráter histórico que tem por objetivos identificar marcos históricos da inserção da enfermeira no atendimento pré-hospitalar, identificar as transformações ocorridas em sua atuação e as conexões com os aspectos legais do exercício profissional. Foram analisados três teses e seis artigos de periódicos, encontrados na consulta às bases de dados LILACS, BDENF E DEDALUS, mais seis documentos legais encontrados em sites de organizações governamentais e Associações de Classe. Os resultados encontrados permitiram apreciar os marcos históricos, a atuação da enfermeira nesta área e os aspectos legais que envolvem seu exercício.

The causes of anaphylaxis and its management in adults.

Anaphylaxis is a potentially life-threatening condition which nurses may encounter while practising in any sphere of nursing. This article reviews the management of adults presenting with severe anaphylaxis in a general hospital setting. It summarizes data obtained from studies on the incidence of anaphylaxis, explains their significance, and defines the terms used when describing the pathophysiology of the condition. This is followed by an examination of the pathophysiology surrounding anaphylaxis with a summary of common causative agents. An overview of the management of patients with anaphylaxis is presented, together with a summary of the literature relating to the legal and ethical issues that nurses may face when encountering patients presenting with or experiencing anaphylaxis.

Legal and ethical issues confronting oncology nursing.

OBJECTIVES: To identify and summarize the legal and ethical issues found in the multiple settings in which oncology nurses practice. DATA SOURCES: Lexis, Medline, Westlaw, federal and state laws, government documents, and nursing and medical textbooks. CONCLUSIONS: Oncology nurses face many legal and ethical dilemmas when delivering care. The best defense against litigation is to be knowledgeable about the specific issues found in each setting, the impact these issues have on practice, and requisite risk reduction practices. IMPLICATIONS FOR NURSING PRACTICE: With the advent of new technology, changing state and federal laws, and new court decisions, the ethical and legal issues nurses will encounter when taking care of cancer patients will not remain the same. Continuing education will be essential if nurses are to remain current, lower their legal liability, and deliver quality care.

Implications of the Health Information Portability and Accountability Act.

The Administrative Simplification regulations of the Health Information Portability and Accountability Act became effective October 16,2000. Compliance is mandated within 24 months of these standards being passed. This new law requires strict security measures to protect the electronic health data of patients. As a result, the policies and procedures associated with the practice of healthcare will change dramatically. It is imperative that nurse executives be aware of these new regulations and become an integral part of the team addressing compliance issues in order to continue providing the best possible care.

Suicide and self-harm in in-patient psychiatric units: a study of nursing issues in 31 cases.

A significant number of incidents of suicide and self-harm occur whilst patients are in receipt of care as in-patients. This audit comprises 31 cases which were referred to the first author for expert opinion, each case being the subject of legal action brought by patients and/or their families. The cases were referred from 31 different NHS trusts across England. All concerned suicide/serious self-harm in people in receipt of in-patient care. The aims of this audit were to carry out a detailed assessment of the 31 individual cases, so as to provide a nursing dimension to already established enquiries in this area and also to examine whether specific issues might be the subject of more systematic research. Further, this paper aims to provide some insights in the area of litigation, where nurses are becoming increasingly involved. The same broad approach to information-gathering and analysis was used, comprising a systematic review of case records, trust policies, expert reports and, where appropriate, inquest transcriptions. The sample comprised 12 suicides and 19 cases of serious self-harm. Factors associated with these events include: being male, having a dual diagnosis of mental illness and drug/alcohol abuse, and age between 21 and 30 years. Of the 12 deaths, five occurred in hospital, four by hanging and one by drowning. The audit highlighted environmental factors associated with these events which, arguably, could be simply addressed. There was a considerable variation in the content and quality of observation policy and practice. The results of this audit point to the need for further research but, above all, provide evidence requiring urgent action by the Department of Health regarding the setting of national standards.

Managing a culturally diverse staff. Legal considerations.

Effective human resource management practices with an increasingly diverse work force must include consideration of relevant employment law. But leading organizations will venture beyond simply avoiding discriminatory practices. Managing staff differences that emerge from cultural diversity begins with awareness, moves toward sensitivity, evolves into understanding, and concludes with respect.