T.J. is a 76-year-old man that recently lost his wife. He lives alone now in an ALF where he has some friends that he associates with. They are “good for his overall well-being” claims the administrators of the facility who befriended T.J. when he lost his wife six months ago. The facility that T.J. lives in is convenient for many aspects of his life, including entertainment and even some of the healthcare associates from neighboring clinics that have partnered with the facility to allow visits with the residents.

Over the years, the associates from the neighboring clinic have grown close to some residents and have followed them during some of their crisis, both emotional and physical. Christine, a nurse practitioner from a neighboring clinic, has followed T.J. for many years and is now assessing his fall risk through a tool called the “Hendrick Fall Risk Tool II” a popular means of assessing the fall risk that may exist for an elderly person. 

An entry by the ARNP recently on T.J. demonstrated that there was enough information, recognizing previous and present knowledge to utilize the tool to give T.J. a score representing his fall risk. the entry reads: “T.J. is a 76-year-old that is evaluated today for his fall risk. He has a MedHx of BPH, COPD, seizures, eczema, and anxiety. He has been seen monthly and he described some episodes of nocturia that still persists. A list of his recent mediation includes Alprazolam, Phenytoin, Dutasteride, and ibuprofen prn. By administering the Get Up and Go Test, we find that he only had a brief episode of not being able to rise but he performed well after that completing it in 12 seconds. He demonstrates an improvement in his depression experienced in the past exhibited for several months after the loss of his spouse. His friends at the facility keep him busy and he is much improved in his outlook for the future.” C. Miller ARNP

Instructions:

1. Read the Fall Risk Assessment for Older Adults article.
2. Complete the Hendrich II Fall Risk Model tool form completely.
   • Assign the correct scores for the Fall Risk Tool.
   • Summarize the scores derived as per fall risk.
3. Develop a summary of the risks for T.J., so that the facility can respond to those risks and provide a safe environment.
4. Describe the level of safety that the facility should plan to give T.J.
5. Finally, explain whether you feel like the score from the Fall Risk Tool is accurate and if the tool is worth the effort to develop.
6. Your paper should be:
   • One (1) page or more.
   • Use factual information from the textbook and/or appropriate articles and websites.
   • Cite your sources – type references according to the APA Style Guide. Include at least 3 references no older than 5 years.

 

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For this discussion, first, review chapters 1, 2, and 4 in your textbook, Transcultural Concepts in Nursing Care. (https://books.google.com/books?id=XCWKCwAAQBAJ&pri…)

Then, address the following questions:

1. In your own words, in one short paragraph each, define each of the following and give an example from your practice (not a list!):
   1. Cultural baggage
   2. Ethnocentrism
   3. Cultural imposition
   4. Prejudice
   5. Discrimination
   6. Cultural congruence
2. Define cultural self-assessment and explain why it is important.
3. Then, describe the five steps in the process for delivering culturally congruent nursing care.

Your initial post must be posted before you can view and respond to colleagues, must contain minimum of two (2) references, in addition to examples from your personal experiences to augment the topic. The goal is to make your post interesting and engaging so others will want to read/respond to it. Synthesize and summarize from your resources in order to avoid the use of direct quotes, which can often be dry and boring. No direct quotes are allowed in the discussion board posts.

 

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How does Negligence and Malpractice Impact The Advance Practice Nurse?

Topic 1: The Legal Implications of Acceptance or Refusal of an Assignment

After reviewing the ANA position statement on “Rights of Registered Nurses when Considering a Patient Assignment,” discuss the legal and ethical implications of accepting assignments. When delegating assignments to unlicensed personnel, what considerations need to be considered? What insurance issues come into play? Analyze the legal principle of Respondeat Superior.

Topic 2: Defenses to Malpractice and Risk Management

Take the malpractice case assigned to your group and discuss the defenses that may be raised in that case. Discuss how the incident could have been prevented. What risk management techniques could have been used before and after the adverse patient occurrence? Respond to the other case scenario.

The Malpractice Case is as follows:

Facts: The plaintiff, Mrs. Carpenter, was a 55-year-old woman who underwent a total hip replacement at Caring Memorial Hospital. The physician was Richard Washington, MD. Dr. Washington is an orthopedic surgeon. His nurse practitioner is Judy Gouda, RN, NP. Dr. Washington reviewed the consent with Mrs. Carpenter prior to surgery. Joseph Alsoff, LPN, witnessed the consent and Mr. Carpenter was present. Joseph does not remember the doctor ever mentioning that death could be a result of the surgery. The recovery room nurse is Elizabeth Adelman, RN. The respiratory therapist is David Casler, LRT. The nurse on the post-surgical unit was Kelly Wheeler, RN. The supervising nurse was Mrs. Scale, RN, MS.

The patient had an epidural catheter for a post-operative pain management following an episode of hypotension in the recovery room which was treated with Ephedrine. Judy Gouda made rounds on the patient in the recovery room after the hypotensive event and vital signs were stable. The patient, Mrs. Carpenter, was placed on a medical surgical nursing unit with the epidural. The nurse, Kelly, was assigned to the patient and had not worked on that unit before, but had worked in post-acute critical care units. The nurse’s assignment was to provide patient care on the entire floor for that shift. There was also an LPN, Joseph, on the unit. It was a busy day on the unit. Mrs. Carpenter was not the only post-operative patient.

Kelly assessed the plaintiff upon admission, checked the IVs, asked if the patient was in pain, noted that the patient was responsive and understood where she was, and was stable. She then left to care for other patients.

The licensed practical nurse, Joseph Alcoff, had been working on the unit for several years. It had been rumored that Joseph was an alcoholic. There was no evidence that he had been drinking on the unit. Approximately an hour after the patient arrived on the unit, she was unable to tolerate respiratory therapy that was ordered and she became nauseated and vomited. David Casler administered the respiratory therapy. According to Kelly, the registered nurse, 10 minutes after the vomiting episode, Joseph Alcoff, the LPN, found the patient blue and unresponsive and called a code. Joseph is the only person other than the physician that carries his own liability insurance. The hospital also has malpractice insurance.

The code team responded, along with Kelly, the registered nurse. Mrs. Carpenter was intubated and cardiac resuscitation was initiated. The patient responded to resuscitative efforts and she was transferred to the intensive care unit. Subsequently, Mrs. Carpenter did not do well, was unresponsive, and declared brain dead and taken off the respirator. She did not have a DNR in place.

There is a conflict in testimony between Joseph the LPN and Kelly the RN. Joseph indicated that Kelly found the plaintiff to be unresponsive after the vomiting episode and called the code. The record is not clear as to when the vital signs and epidural site were assessed. Kelly said she did a motor and sensory level assessment and they were fine — it is not charted though. The time elapsed between the vomiting episode and finding the patient is in dispute. The final diagnosis was anoxia encephalopathy due to the time lapse between CPR being initiated. The patient was eventually extubated, breathed independently for a period of time, and then subsequently expired.

The vital signs ordered by the physician were hourly. The hypotensive episode in the recovery room had not been reported to the registered nurse.

The risk manager is Susan Post, JD, who works in collaboration with the quality assurance director Amy Green. Amy had noted when doing chart reviews over the last 3 months prior to this incident that the vital signs taken in the recovery room were not charted, not done, or not reported to the units. She was in the process of collecting data from the different units on this observation. She also noted a pattern of using float nurses to several postoperative units. Prior to this incident, the clinical nurse specialist, Michael Parks, RN, MS, CNS, was consulting with Susan Post and Amy Green about the status of staff education on these units and what types of resources and training was needed.

Reading

Textbook Readings

Essentials of Nursing Law and Ethics

• Chapter 5: “Defenses to Negligence or Malpractice”
• Chapter 6: “Prevention of Malpractice”
• Chapter 7: “Nurses as Witnesses”
• Chapter 8: “Professional Liability Insurance”
• Chapter 9: “Accepting or Refusing an Assignment/Patient Abandonment”
• Chapter 10: “Delegation to Unlicensed Assisted Personnel”
• Chapter 37: “Staffing Issues and Floating”

Journal Readings

Please retrieve and read the following journal articles. Articles can be located through a search in the CINAHL database, OVID databases in the library.

American Nurses Association Nursing World. (2016). Patient safety: Rights of registered nurses when considering a patient assignment. Retrieved from

American Nurses Association Nursing World. (2009). Patient safety: Rights of registered nurses when considering a patient assignment. Retrieved fromhttp://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/ANAPositionStatements/Position -Statements-Alphabetically/Patient-Safety-Rights-of-Registered-Nurses-When-Considering-a-Patient-Assignment.html

Anselmi, K. K. (2012). Nurses’ personal liability vs. employers’ vicarious liability. MEDSURG Nursing, 21(1), 45–48.

Web Resources

• Reference in APA format

 

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Baptist Hospital is a 175-bed community hospital serving a rural area of Jacksonville. It is located 30 miles from a large metropolitan area and has a fine reputation.

The hospital is fully accredited and is licensed by the state. The hospital offers general medical/surgical services with a bed complement as follows:

Medical/Surgical 130

Pediatrics 20

ICCU 10

OB 15

Total 175

The hospital has a 10 bed Ambulatory Surgical Unit. The hospital is in sound financial condition with a physical plant that is 15 years old and in excellent condition.

The hospital has just recruited a new General Surgeon and a Internist. These recruitment efforts filled two major needs of the institution. It is estimated that in today’s current marketplace surgeons are expected to increase inpatient admissions to a acute care community hospital by 1.5% and Internists by .5%.

It is expected that admission volumes will increase with the addition of these two new physicians.

The community population has been relatively stable over the past 10 years and there is no expectation that this trend will change.

The percentage breakdown of patients by payor mix is as follows:

Medicare 51%

Blue Cross 16%

Medical Asst 08%

HMO 10%

Commercial INS 07%

Other 05%

Self Pay 03%

Total 100%

The population breakdown is as follows:

                     Under 19    25%

19 to 64 44%

65 and over 31%

The primary initiative or goal for the 2014-2015 fiscal year is the establishment of a 15-bed Psychiatric Unit. This new unit will be infused into the current bed complement with no increase in the 175 bed count expected. This unit is expected to occupy space for 15 beds currently not set up and staffed at the hospital.

It is expected that during the year there will be a slight increase in inpatient services as a result of the Psychiatric Unit. The hospital laboratory is buying two new pieces of equipment at a cost of $400,000 that will allow them to do 35% more tests in house rather than send these tests out to a reference lab. It is also expected that the Radiology Department is purchasing a new CT scanner that is expected to increase current radiology volumes by 3.25%.

The budget calendar and target dates for budget completion are the same in this year’s budget as in years past.

In the new fiscal year, the hospital plans to:

Establish a separate distinct 15-bed inpatient psychiatric unit.
Install new equipment in the laboratory to enable the hospital to do 35% more tests in-house rather than send them to a reference lab.
Recruit a general surgeon and a Internist.
Purchase an additional CT scanner which is expected to increase current radiology volumes by 3.25%.
THREE DEPARTMENTS ARE INVOLVED IN OUR BUDGET EXERCISE. THEY ARE NURSING, LABORATORY, PHARMACY AND OUTPATIENT/AMBULATORY SERVICES.

STATISTICAL DATA

2012  2013  2014  2015

Admissions In Pt (Nursing) 7,395 7,400 7,370

Laboratory Test 399,330 411,810 421,564

Pharmacy Rx 99,832 100,011 99,642

Radiology Exams 68,222 69,124 68,950

Laboratory spent $79,866 on supplies in 2012. They spent $86,480 in 2013 and $96,959 in 2014. These figures represent the cost of supplies to do tests at the hospital. The hospital spent $122,000 to perform tests outside the hospital last year. The cost of lab supplies is expected to increase 10% in the next budget year as a result of inflation. The hospital also had supplies costs in Radiology of $ 395,205 in 2012, $405,222 in 2013 and 410,100 in 2014. There is expected to be an industry wide increase in radiology supplies costs of 6.5% in the next budget year.

LABORATORY EXPENSES

                                                       2012                   2013               2014

Supplies $79,866 $86,480 $96,959

RADIOLOGY EXPENSES

Supplies $395,205 $405,222 $410,100

NURSING JOB CLASSIFICATION LISTING

POSITION TITLE AUTHORIZED POSITIONS

Director of Nursing 1 ft

Assistant Director 2 ft

Nurse Supervisors 4 ft

Head Nurse 8 ft

Staff Nurses RN 80 ft

                                                        15 pt

LPN 25 ft

                                                        10 pt

Nurses Aides 10 ft

Orderlies 6 ft

Unit Desk Clerks 6 ft

                                                          4 pt

Secretary 1 ft

LABORATORY

Department Head 1 ft

Med Technologist 12 ft

                                                           2 pt

Lab Tech 4 ft

Lab Assistant 2 ft

Secretary 1 ft

PARIENT REVENUE

Gross Revenue Projected for the 2014-2015 budget year is as follows:

In Patient $30,675,000

Out Patient $36,878,000

Total $67,553,000

Current Reimbursement Formulas:

                                       In PatientOut Patient

Medicare $5760/case 38% of Charge

HMO $1215.00/pat day 31% of Charge

Other Insurance $7655.00/discharge 42.5% of Charge

Expected length of stay (LOS) in 2015 is 3.4

INSTRUCTIONS:

Describe the mission, assumptions and objectives for the upcoming budget year for the departments involved. (Nursing, Laboratory, Pharmacy & Radiology)
Establish statistics volume projections for the budget year 2015 for all four (4) departments.
Establish a position control plan for the new Psychiatric Unit. (Part of Nursing)
Establish a position control plan for nursing and laboratory.
Complete expense item for laboratory & radiology for 2015.
Project the expected net revenue for all Medicare, HMO, and all Other Insurance patients.

 

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