Fitzgerald Health Education Associates (FHEA) is committed to the success of nurse practitioners; we publish practical information for practicing NPs and NP students, which includes NP interviews, NP certification Q&A;, avoiding malpractice, and news.
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Click to View Previous Issues... L ook for b old orange text for clickable web links. Our " i " information icon is a clickable web link. Certification Q&A; Caring for Asian Patients: Cultural Factors That Can Influence Patient Care M argaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC I R ECENTLY LEARNED that issues related to culture and health care are included on the exam. What are some key cultural issues pertaining to the care of A sian patients that I should know as I prepare for the exam? A sians are the fastest-growing ethnic group in the United States, with a population that in- creased from 11.9 million in 2000 to 17.3 million persons in 2010. 1 The largest Asian groups—Chinese, Indian, Fil- ipino, Vietnamese, Korean, and J apanese—account for over t hree-quarters of the Asian pop- ulation in the United States, and the remaining quarter is distrib- uted among 19 other detailed groups counted in the 2010 census. Asian Americans as a group are ethnically and linguistically diverse. However, individuals from the various ethnic groups can experience similar problems when accessing health care in Western health s ystems. Especially for first-generation immigrants, these problems are generally related to language barriers and differing styles of communicating, holistic health beliefs and practices that differ from the Western health care model, and reliance to some extent on traditional therapies. By learning about Asian cul- tures, communication patterns, and traditional health practices, NPs can better position themselves to provide culturally competent care to their Asian Inside Certification Q&A; ............. 1 Review Courses ................ 6 Malpractice ....................... 7 U pdate: Patient Satisfaction ...................... 13 Update: Tobacco Use...... 15 N ews Briefs ..................... 18 2015 Live Courses Pharmacology Update (2-day course) The Art of Wound Repair (1-day course) NP Essentials (4-day course) NP Certification Exam Review C ourse Tracks Family, Adult-Gerontology, and Adult Primary Care A dult-Gerontology Acute Care P ediatric Primary Care Psychiatric-Mental Health W omen's Health Fitzgerald Health Education Associates, Inc. f hea.com Committed to the success of nurse practitioners 1 Fitzgerald Health Education Associates, Inc. 978•794•8366 Volume 15, Issue 4, April 2015 Look for bold orange text for clickable web links. Our " i " information i con is a clickable w eb link. Expanding NP Scope of Practice: An Update E arlier this year, Nebraska and Maryland joined 19 other states that allow NPs to practice to the fullest extent of their education by enacting new full prac- tice authority licensure and practice laws for NPs. For new NP graduates as well as practicing NPs, this means more opportunities for NPs to use the full set of skills acquired through education and clinical experience. In many states, how- ever, there remains a gap between the care that NPs are educated and clinically prepared to provide and the care that state practice laws allow NPs to provide. Types of State Practice Laws T he American Association of Nurse Practitioners (AANP) has been at the fore- front of efforts to expand NPs' scope of practice. As the AANP notes, full practice authority is "the collection of state practices and licensure laws that allow for NPs to evaluate patients, diagnose, order, and interpret diagnostic tests, initiate and manage treatments—including prescribing medications—under the exclu- s ive licensure authority of the state board of nursing." 1 W ith full practice authori- ty, NPs are responsible only to a state board of nursing for meeting the stan- dards of care. The AANP also defines two categories of state practice and licensure limits on N P scope of practice: reduced practice and restricted practice. In states with a r educed practice regulatory structure, NPs are required by law to have a collabo- rative agreement with an outside health discipline in order to provide patient I nside NP Scope of Practice ....... 1 Review Courses ................ 6 C ertification Q& A ............. 7 D iagnostic Challenge ...... 15 News Briefs ..................... 17 FHEA Faculty News ..........24 2015 Live Courses Pharmacology Update ( 2-day course) The Art of Wound Repair ( 1-day course) NP Essentials ( 4-day course) NP Certification Exam Review C ourse Tracks Family, Adult-Gerontology, a nd Adult Primary Care Adult-Gerontology Acute Care P ediatric Primary Care P sychiatric-Mental Health Women's Health F itzgerald Health Education Associates, Inc. fhea.com Committed to the success of nurse practitioners 1 Fitzgerald Health Education Associates, Inc. 9 78 •7 94 •8 366 Volume 15, Issue 5, May 2015 Full Practice Reduced Practice R estricted Practice Used with permission from AANP. DC Look for bold orange text for clickable web links. Our " i " information icon is a clickable web link. Avoiding Malpractice: A Case Analysis A Twist on the Consequences of Not Following Payer Rules Carolyn Buppert, NP, JD I am apprehensive when I hear about nurse practitioners who practice in organi- zations that have not dotted every "i" and crossed every "t" to conform to the letter of the law when it comes to rules about provider supervision, board cer- t ifications, and Medicare and Medicaid payer rules. Everyone may be blissfully ig- n orant—until something goes wrong. Here is a case that justifies paying attention to all these legal details. CASE A teenager was having behavior problems in school and the school referred her to a m ental health clinic for counseling. Medicaid covered the girl's healthcare. The school notified the parents that the girl would not be allowed to take classes unless she saw a psychiatrist. At the clinic, the patient was referred to a cli- nician, "Dr. O," who is a nurse practitioner. The NP diagnosed bipolar disorder and prescribed oxcarbazepine, an anticon- vulsant. The girl had an adverse reac- t ion to the medication. Her parents t ried to call the NP twice, but phone calls were not returned. The parents decided to stop the girl's medication, and she had a seizure, which required hospitalization. After speaking with the N P, the girl resumed the medication. Five months later the girl had another seizure and died. The parents filed complaints with various state agen- cies, and, in doing so, learned that the NP was not a psychiatrist. State regulations re- quire that a psychiatric NP be supervised by a board-certified psychiatrist and that I nside Avoiding Malpractice ...... 1 Diagnostic Challenge........ 5 R eview Courses ................ 8 Certification Q& A ............. 9 Update: STD Treatment Guidelines.........................15 News Briefs ..................... 19 2015 Live Courses Pharmacology Update (2-day course) The Art of Wound Repair ( 1-day course) NP Essentials (4-day course) N P Certification Exam Review Course Tracks Family, Adult-Gerontology, a nd Adult Primary Care Adult-Gerontology Acute Care P ediatric Primary Care Psychiatric-Mental H ealth W omen's Health F itzgerald Health Education Associates, Inc. fhea.com Committed to the success of nurse practitioners 1 Fitzgerald Health Education Associates, Inc. 978•794•8366 Volume 15, Issue 6, June 2015 May 2015 June 2015 April 2015 Look for bold orange text for clickable web links. Our " i " information icon is a clickable web link. ALLERGY & ASTHMA CONSULT Seasonal Allergic Rhinitis: A Blooming Nightmare This Year! C hristy Yates, MSN, FNP-BC, NP-C, AE-C D id this year's allergy season seem to be particularly severe for your patients w ith seasonal allergic rhinitis or perhaps even for you? Was there something unique about this season's pollen load? Did you have a harder time provid- ing allergy symptom relief for your patients this year? If so, you are not alone. I have p rovided care for patients with allergies and asthma for the past 15 years, both in specialty practice and in primary care, and this allergy season seemed particularly s evere for my patients. An unusually wet fall in 2014 followed by an unusually wet and cold winter in 2015 primed the plants and root systems to produce more pollen this spring and summer. Whether or not a "pollen v ortex" occurred this year is debatable, but the weather pattern did lead to more pollen produc- tion and therefore a worse allergy season. Once again, according to the Asthma and Allergy Foun- dation of America, Louisville, KY, where our prac- tice is located, was in the top five Spring Allergy Capitals this spring. Many other cities across the country were hit hard this year. Whatever the severity of the allergy season, I hear many questions and comments from pa- t ients about their allergies. These are some of the most common. I am 54 years old and have never had allergy symptoms. Can I suddenly develop allergies at m y age? Inside Allergy & Asthma Consult ............................. 1 Certification Q& A ............. 7 Review Courses ................ 8 Avoiding Malpractice .... 13 News Briefs ..................... 18 2 015 & 2016 Live Courses Pharmacology Update (2-day course) The Art of Wound Repair (1-day course) N P Essentials ( 4-day course) NP Certification Exam Review Course Tracks Family, Adult-Gerontology, and Adult Primary Care A dult-Gerontology A cute Care Pediatric Primary Care Psychiatric-Mental Health W omen's Health Fitzgerald Health Education Associates, Inc. fhea.com Committed to the success of nurse practitioners 1 Fitzgerald Health Education Associates, Inc. 978•794•8366 Volume 15, Issue 7, July 2015 continued on page 3... July 2015 Look for bold orange text for clickable web links. Our " i " information icon is a clickable web link. Certification Q&A; Assessing Patient Decision-Making Capacity in Clinical Practice Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC A S A STUDENT, I learned that a patient must be considered capable of making decisions in order for informed consent to be valid. How do I determine whether a patient has the ability to make an informed decision in daily clini- cal practice? Respect for a patient's right to make autonomous choices regarding his or her health care is a fundamental ethical principle underlying all healthcare interac- tions between clinician and patient. Clinicians show respect for autonomy by ob- taining informed consent, whereby the patient makes an autonomous decision to undergo or forgo a procedure or treatment or to take part in research. For informed consent to be valid, the patient must have the ability to make healthcare decisions, a concept known as decision-making capacity. 1 Because the clini- cian's assessment of decision-making capacity has important ethical implications for a pa- tient's self-determination—that is, what role the patient will play in making choices about his or her own health care—all clinicians should have a good understanding of deci- sion-making capacity and how to assess it. What is capacity and how is it assessed? Decision-making capacity is a functional assessment and a clinical determination made by a clinician regarding whether a patient possesses the ability to make in- formed decisions about his or her health care. It differs from competence, which is a legal concept that can be formally determined only by a judge in court. Inside Certification Q& A ............. 1 Review Courses ................ 8 A llergy & Asthma C onsult ............................. 9 A voiding Malpractice .... 17 N ews Briefs ..................... 21 2015 & 2016 Live Courses Pharmacology Update (2-day course) The Art of Wound Repair (1-day course) NP Essentials (4-day course) NP Certification Exam Review Course Tracks Family, Adult-Gerontology, and Adult Primary Care Adult-Gerontology Acute Care Psychiatric-Mental Health Women's Health Pediatric Primary Care Fitzgerald Health Education Associates, Inc. fhea.com Committed to the success of nurse practitioners 1 Fitzgerald Health Education Associates, Inc. 978•794•8366 Volume 15, Issue 8, August 2015 continued on page 3... August 2015