State Laws and Regulations Addressing Nurse-Initiated Protocols and Use of Nurse-Initiated Protocols in Emergency Departments: A Cross-Sectional Survey Study.

INTRODUCTION: State regulations may impede the use of nurse-initiated protocols to begin life-saving treatments when patients arrive to the emergency department. In crowding and small-scale disaster events, this could translate to life and death practice differences. Nevertheless, research demonstrates nurses do utilize nurse-initiated protocols despite legal prohibitions. The purpose of this study was to explore the relationship of the state regulatory environment as expressed in nurse practice acts and interpretive statements prohibiting the use of nurse-initiated protocols with hospital use of nurse-initiated protocols in emergency departments. METHODS: A cross-sectional approach was used with a nationwide survey. The independent variable categorized the location of the hospital in states that have a protocol prohibition. Outcomes included protocols for blood laboratory tests, X-rays, over-the-counter medication, and electrocardiograms. A second analysis was completed with New York State alone because this state has the strongest language prohibiting nurse-initiated protocols. RESULTS: A total of 350 participants returned surveys from 48 states and the District of Columbia. A hospital was more likely to have policies supporting nurse-initiated protocols if they were not in a state with the scope of practice prohibitions. Four categories emerged such as advantages, approval, prohibition, and conditions under which the protocols can be used. Prohibitive language was associated with less protocol use for emergency care. CONCLUSION: State scope of practice inconsistencies create misalignment with emergency nurse education and training, which may impede timely care and contribute to inequalities and inefficiencies in emergency care. In addition, prohibitive language places practicing nurses responding to emergencies in crowded work environments at risk.

[For discussion: Quality assurance in medical care - is PKMS the right way to go?]. / Zur Diskussion: Qualitätssicherung in der Pflege - mit PKMS auf dem richtigen Weg?

Hospitals are legally obliged to take part in external comparative quality assurance programs. Quality indicators for pressure ulcer prevention are among the most widely used for geriatric clinical institutions. To enable more precise risk adjustment established risk factors are employed in conjunction with the OPS 9-200. Using a PKMS case to produce an OPS 9-200 is far too heterogeneous, sketchy and vague to create an accurate and satisfactory pressure ulcer risk assessment for patients with varied and individual case factors. Therefore we propose to include risk factors which, according to experts, are clearly and specifically related to pressure ulcers (e.g. immobility and incontinence) and matched by unique ICD codes.

Leading the Way: Implementing a Domestic Violence Assessment Pilot Project by Public Health Nurses.

The current healthcare system requires nurses to utilize innovations and effective leadership to achieve positive health outcomes for their patients. Public health nurses (PHNs) are in a unique position to utilize leadership and advocacy to increase the overall health and well-being of their clients. Domestic violence (DV) is a serious and widespread public health issue and PHNs have a crucial role in providing a preventative and coordinated approach to identifying and responding to DV. This article describes the process through which a group of front line PHNs took an active role in leading the development and implementation of a pilot project to address DV within their practice area. Through the development of a working group, a foundation for guidance was established to reinforce the role of the PHNs in advocating for the need to shift the focus of DV interventions from a reactive to a proactive approach. The DV assessment pilot project is an example for practice and a motivator for nurses to be leaders for change within their practice areas.

[Treating female victims of violence in a medical-judicial unit]. / Prise en charge des fenmmes victimes de violences en unité médico-judiciaire.

Receiving and treating victims of violence is one of the missions of the medical-judicial unit. The nurse is present when the victims arrive and works with the medical examiner during the consultation. Having a nurse's perspective within this unit has helped to improve the global care of the people seen here.

Gaining independent prescriptive practice: one state's experience in adoption of the APRN Consensus Model.

Nurses are increasingly encouraged to be active participants in health policy. This article provides an exemplar of how nurse practitioners (NPs) in one state, North Dakota, used strategic policy actions to obtain independent prescriptive privileges. Consistent and clear communication among NPs and with key stakeholders, including legislators, contributed to a positive policy outcome. North Dakota nurse leaders in this initiative have shared their experiences with a variety of audiences including other state boards of nursing and NP organizations in states such as New York, South Dakota, and Louisiana. In addition, a webinar sponsored by the Center to Champion Nursing in America at AARP featured several of the North Dakota NP leaders, who shared their reflections of this experience and the strategies they used. Regulatory environments and public policies will continue to significantly influence the future of all nurses. This case study of one state can be useful to NPs and other nurses seeking meaningful policy change through laws or regulations with regard to scope of practice or other health policy issues.

Satisfacción laboral de los profesionales de enfermería en las unidades de gestión clínica / Job stisfaction of nurses in the clinical management units

La Unidad de Gestión Clínica (UGC) se ha establecido actualmente en las instituciones sanitarias andaluzas como el modelo de gestión de referencia. Este modelo de gestión pretende instaurar en los profesionales sanitarios una idea-fuerza: el mayor rendimiento de los recursos sanitarios se realiza impulsando la práctica clínica que utilice el menor número de recursos diagnósticos y terapéuticos. La UGC no solo tiene como objetivo el ahorro económico, en el Acuerdo de Gestión Clínica [1] se valoran todas las dimensiones que la integran: la investigación, la formación, el proceso clínico, la cartera de servicios, los objetivos, la gestión económica y los indicadores de control y de seguridad. En ella se pretende transferir más responsabilidades a los profesionales sanitarios, implicándolos en la gestión de la Unidad. La UGC establece nuevos enfoques que afectan directamente a los profesionales sanitarios y plantea ventajas e inconvenientes para los facultativos y los profesionales de enfermería, implicados en la consecución de la excelencia en la labor asistencial. Estos últimos se muestran expectantes ante los cambios que se van generando en las instituciones sanitarias y aparece un debate acerca de las competencias que se derivan de la misma. Algunos profesionales de enfermería consideran que la presión asistencial a la que se ven sometidos en las instituciones públicas ha aumentado desde la aparición de la UGC y, sin embargo, otros se sienten motivados y recompensados por los resultados que obtienen con este modelo de gestión. En las instituciones sanitarias algunos profesionales se sienten más motivados que otros y esto se constata en el resultado de la actividad asistencial [2]. Ante las percepciones positivas y negativas que la UGC plantea, se considera pertinente centrar el objetivo de este trabajo en la búsqueda de los factores que influyen en la satisfacción laboral de los profesionales de enfermería de la UGC. Son escasos los estudios realizados acerca de la misma [3] pero resultan inexistentes si se vinculan con la enfermería; por tanto, la búsqueda del conocimiento científico de enfermería relacionado con el modelo de gestión clínica y fundamentado en la calidad asistencial puede llevar a establecer nuevos conceptos en torno a la profesión enfermera, profesión en la que se vislumbran importantes cambios cuando el Grado sea efectivo(AU)

Clinical Management Unit (CMU) is currently set in the Andalusian health institutions as the model reference management. This management model aims to make all healthcare professionals a powerful idea: the best performance of health resources is performed to drive clinical practice using the least number of diagnostic and therapeutic resources. The CMU not only aims at saving money, in the Clinical Management Agreement [1] are measured all the dimensions that make up the UGC: research, training, clinical process, the portfolio of services, objectives, financial management and indicators to control and security. The CMU is to transfer more responsibilities to Health Care Professionals, involving them in the management of the Unit. The CMU sets new approaches that directly affect health professionals and presents advantages and disadvantages for the Doctors and the Nurses, involved in achieving excellence in care work. Nurse Practitioners shows expectant before the changes are generated in health institutions and appears a discussion of skills derived from the CMU. Some Nurses believe that the burden of care to which they are subjected in public institutions has increased since the onset of the CMU and yet others believe that they are motivated and rewarded for the results obtained with this model of management. In health institutions, some professionals are more motivated than others and this is found in the outcome of health care activity [2]. Given the positive and negative perceptions that arise in the CMU Professional Nurses, it is considered appropriate to focus the objective of this work in the search for factors that influence job satisfaction of nurses in the CMU. There are few studies about the CMU [3] but are absent when linked with nursing, so the pursuit of scientific knowledge related to nursing management model based on Clinical and Quality Care can lead to establish new concepts around the nursing profession, a profession in which major changes are foreseen when the Grade is effective(AU)

Consent to care: assessing patient decision-making capacity.

Decision-making capacity has been described as the 'key to autonomy'. A person who is capable of making a decision about their health care must have that decision respected by a district nurse, as to proceed against the person's wishes would amount to the tort of trespass to the person and, in some cases, a criminal assault. It is essential, therefore, that district nurses are able to assess the decision-making capacity of their patients.

[The needs of elderly or disabled inmates in Basse-Normandie]. / Les besoins des détenus âgés ou handicapés en Basse-Normandie.

The Regional Healthcare Observatory has carried out a study of the health of elderly or disabled inmates in Basse-Normandie. Its objective is to identify more clearly the different situations of dependency and the difficulties expressed by professionals and inmates in order to draw up certain recommendations.

[A determined team caring for an elderly detainee]. / Prise en soins d'un détenu âgé, une équipe déterminée.

The arrival of an elderly person in a remand centre reveals the extent to which the prison system is ill-equipped to deal with this type of detainee. The cooperation between the prison, nursing and social care teams however compensates for the many difficulties his case presents.