Assignment: Ethical and Legal Implications of Prescribing Drugs

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?

These are some of the questions you might consider when selecting a treatment plan for a patient. 

As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

To Prepare

Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.

Review the scenario assigned by your Instructor for this Assignment.

Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.

Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.

Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.

ASSIGNMENT:

The scenario for this week’s assignment is below:

A friend calls and asks you to prescribe a medication for her. You have this autonomy, but you don’t have your friend’s medical history. You write the prescription anyway.

Write a 2- to 3-page paper that addresses the following:

Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.

Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.

Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation. 

Explain the process of writing prescriptions, including strategies to minimize medication errors

REQUIRED READINGS;

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Chapter 1, “Prescriptive Authority” (pp. 1–3)

Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 5–9)

Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 11–16)

Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 17–40)

Chapter 5, “Adverse Drug Reactions and Medical Errors” (pp. 41–49)

Chapter 6, “Individual Variation in Drug Response” (pp. 51–56)

American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694. doi:10.1111/jgs.15767

American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society, in Journal of the American Geriatrics Society, Vol. 67/Issue 4. Copyright 2019 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.

his article is an update to the Beers Criteria, which includes lists of potentially inappropriate medications to be avoided in older adults as well as newly added criteria that lists select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug-drug interactions documented to be associated with harms in older adults.

Drug Enforcement Administration. (n.d.-a). Code of federal regulations. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm

This website outlines the code of federal regulations for prescription drugs.

Drug Enforcement Administration. (n.d.-b). Mid-level practitioners authorization by state. Retrieved May 13, 2019 from http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html

This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.

Drug Enforcement Administration. (2006). Practitioner’s manual. Retrieved from http://www.deadiversion.usdoj.gov/pubs/manuals/pract/index.html

This manual is a resource for practitioners who prescribe, dispense, and administer controlled substances. It provides information on general requirements, security issues, recordkeeping, prescription requirements, and addiction treatment programs.

Drug Enforcement Administration. (n.d.-c). Registration. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/drugreg/index.html

This website details key aspects of drug registration.

Fowler, M. D. (2015). Guide to the code of ethics for nurses with interpretive statements: Development, interpretation, and application. Silver Spring, Maryland: American Nurses Association, 2015. 

This resource introduces the code of ethics for nurses and highlights critical aspects for ethical guideline development, interpretation, and application in practice.

Institute for Safe Medication Practices. (2017). List of error-prone abbreviations, symbols, and dose designations. Retrieved from https://www.ismp.org/recommendations/error-prone-abbreviations-list

This website provides a list of prescription-writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.

Ladd, E., & Hoyt, A. (2016). Shedding light on nurse practitioner prescribing. The Journal for Nurse Practitioners, 12(3), 166–173. doi:10.1016/j.nurpra.2015.09.17

This article provides NPs with information regarding state-based laws for NP prescribing.

Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner students. Journal of the American Association of Nurse Practitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446

The authors of this article assess the impact of a pharmacist‐led educational intervention on family nurse practitioner (FNP) students’ prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator.

 

For this Assignment you are creating a PowerPoint® presentation. Your presentation audience is the community. The topic is immunization/ vaccination. Information should include herd immunity, types of immunity related to vaccination, immunization effects on the individual, and community as well as worldwide effects of immunization. Additionally content should include vaccination trends, myths, disease statistics for those conditions prevented with vaccination, and pediatric vaccination schedule/s. Legal, ethical, and cultural considerations should be addressed.

Master’s-prepared nurse educators, leaders, nurse practitioners and all specialty nursing fields are contributors to health promotion in populations across the life span. This Assignment is focused on the child and adolescent immunization, health information, epidemiology and surrounding influences. You should apply the topic towards your area of specialty focus as it relates to health promotion and epidemiology.

The presentation must have speaker notes per slide; 1–3 paragraphs. The PowerPoint should be developed in a professional design and style; succinct, not overly wordy, with a tasteful amount of elegant text and visual appeal, as well as accurate and complete content. Number of content slides are 12, not to exceed 14. Title slide and reference slide required and not included in the total. This presentation should adhere to appropriate 6th edition APA format.

Number of content slides are 12, not to exceed 14. Title slide and reference slide required and not included in the total. This presentation should adhere to appropriate 6th edition APA format.

This link provides Microsoft tutorials in PPTX:

PowerPoint 2013 videos and tutorials. (n.d.). Retrieved from https://support.office.com/en-us/article/PowerPoint-2013-videos-and-tutorials-bd93efc0-3582-49d1-b952-3871cde07d8a

Bioethics Case Study: This assignment asks you to examine a current ethical controversy case study. The paper is informal, but should be in APA style, and does not need an abstract or cover page. With a minimum of two pages and a maximum of four pages A reference page is needed. In-text citations should be in APA format. Papers will be graded on a 0 to 25-point scale.

Case Study in Primary care:

One hypothetical case study involves Jim a 54, year old patient who has recently diagnose with hypertension and his Creatinine and BUN laboratory results are elevated, if left untreated, will result in kidney failure. The patient refuses to take the medication because he said it will affect his sex life The NP must work with the patient to respect the fact that he doesn’t want the medication (autonomy), and needs to find a solution that would prevent him from going into kidney failure and other complications, which is in his best interest (beneficence). Although medications are the best choice, forcing the patient to accept the medication will result in probably patient leaving the care (non-maleficence). Finally, the NP needs to consider the impact that the patient’s choices might have on others if he starts to go into preventable kidney failure, he’ll need dialysis, which affects other people who need the same treatment (justice). So before making the final decision the NP must consider all four principles of health care ethics, which will help the NP make the choice that will have the best possible benefits for both the patient and society.

Questions?

1. What are the skills necessary for the provider to identify, address, and assess this clinical ethical issue?
2. What are the provider’s obligations when a patient discloses does he not intent to follow the treatment?
3. What are the ethical considerations in evaluating a patient’s failure to adhere to a prescribed therapy?
4. Will you terminate care for this patient? What are the implications?

• Case Study Rubric
  CriterionOutstanding  (25)Very Good  (22)   Average (18)Unacceptable (15)ScoreCompletenessComplete in all respects; reflects all requirementsComplete in most respects; reflects most requirementsIncomplete many respects; reflects few requirementsIncomplete in most respects; does not reflect requirements UnderstandingDemonstrates excellent understanding of the topic(s) and issue(s)
  Demonstrates an accomplished understanding of the topic(s) and issue(s)Demonstrates an acceptable understanding of the topic(s) and issue(s)Demonstrates an inadequate understanding of the topic(s) and issue(s) AnalysisPresents an insightful and through analysis  of the issue (s) identifiedPresents a thorough analysis of most of the issue(s) identifiedPresents a superficial analysis of some of the issue(s) identifiedPresents an incomplete analysis of the issue(s) identified. EvaluationMakes appropriate and powerful connections between the issue(s) identified and the concept(s) studiedMakes appropriate connections between the issue(s) identified and the concept(s) studiedMakes appropriate but somewhat vague connections between the issue(s) identified and the concept(s) studiedMakes little or no connection between the issue(s) identified and the concept(s) studied. OpinionSupports opinion with strong arguments and evidence; presents a balanced and critical view; interpretation is both reasonable and objectiveSupports opinion with reasons and evidence; presents a fairly balanced view; interpretation is both reasonable and objectiveSupports opinion with limited reasons and evidence; presents a somewhat one-sided argumentSupports opinion with few reasons and little evidence; argument is one-sided and not objective. RecommendationsPresents detailed, realistic, and appropriate recommendations clearly supported by the information presented and concepts studiedPresents specific, realistic and appropriate recommendation supported by the information presented and the concepts studiedPresents realistic or appropriate recommendation supported by the information presented and the concepts studiedPresents realistic or appropriate recommendation with little, if any, support from the information and the concepts studied. Grammar and SpellingMinimal spelling and grammar errorsSome spelling and grammar errorsNoticeable spelling and grammar errorsUnacceptable number of spelling and grammar errors APA guidelinesUses APA guidelines accurately and consistently to cite sourcesUses APA guidelines with minor violations to cite sourcesReflects incomplete knowledge of APA guidelinesDoes not use APA guidelines                 Total
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Fundamentals Clinical Makeup Assignment

Summer 2021

Student Name:

Assessment

1. Make a list of variables that may impair a nurse’s ability to gather data that are complete, accurate, factual, and relevant.

2. In a brief report, describe the purpose of the four types of nursing assessments (initial assessment, focused assessment, emergency assessment, time-lapsed assessment), and give an example of a case in which each would be conducted.

Diagnosing

3. Explain the following statement: The etiology of the problem directs the nursing intervention.

4. Case Study: A 16-year-old girl delivers her baby at home in her bedroom. Her parents find her and bring her and her baby to the emergency department. The baby is premature and in respiratory distress, and the mother has uncontrolled bleeding. The mother blames the situation on her daughter’s boyfriend, a fellow classmate, who denies any responsibility for the baby.

Make a list of one of the following areas:

(a) patient strengths:

(b) patient problem areas:

(c) potential patient problems:

Outcome Identification and Planning

5. Read the following situation and respond in writing to the accompanying questions:

A client is a 49-year-old homemaker seen in the emergency department to rule out fractures. She states that she lost her balance and fell down her basement stairs. Her husband is constantly at her side, and she appears fearful. You recall previous admissions for lacerations, bruises, and a fracture.

· How would you develop and prioritize the patient’s nursing diagnoses?

· What would be appropriate long- and short-term goals for the priority nursing diagnosis?

· What would be appropriate nursing orders for the priority nursing diagnosis?

Implementing

6. Using the Internet (must be a credible source- include citation and reference list), research a new nursing strategy or practice that has proven effective and write a paragraph about how you could incorporate this into your own nursing practice.

Evaluating

7. Describe how you use your weekly clinical experiences to develop self-awareness of your clinical strengths and weaknesses. What would be your plan for self-improvement? Then, discuss the value of reflection and self-awareness.

8. Discuss the following statement and its implications: We owe it to our patients to be the best nurses we can be.

Case Studies, Urinary Elimination

1. You are a hospital nurse caring for a 62-year-old accountant who was admitted following a motor vehicle accident. During her hospitalization, a significant lack of urination was detected. Her primary care physician has ordered significant testing while the patient is recovering from her injuries.

a. What circumstances could be causing her infrequent urination?

b. How can infrequent urination negatively impact a patient’s health?

c. Outline how urination may be affected by the effects of aging.

d. Describe the effects of decreased bladder and sphincter tone on urination.

e. What can cause decreased urinary structure muscle tone?

2. You are a urologic nurse whose patient has voiced concern over his kidneys losing their function within the past few weeks. He has maintained a log of the past week, recording his urination and fluid intake. He has a history of diabetes mellitus and hypertension, which are treated with medication.

a. In your patient interview, how would you define renal failure for your patient?

b. Which diseases could be included as possible etiologies for renal failure?

c. What data should be included in a complete urinary system assessment?

d. How might an accurate urinary output measurement be obtained?

e. What is important to remember when collecting a 24-hour urine specimen?

Case Studies, Bowel Elimination

3. You are a visiting nurse checking in on your patient, a 93-year-old retired steelworker who lives alone with his two cats. You visit him on a weekly basis to monitor his blood glucose levels and refill his insulin syringes for his self-medicating throughout the week, as he is visually impaired. During your interview, he indicates that he has been experiencing irregularity and is quite anxious over developing a bowel obstruction.

f. How would you assess his bowel elimination patterns?

g. Describe foods that impact bowel elimination either positively or negatively.

h. What activities could you recommend to maintain adequate bowel function?

i. Outline how fiber and fluid intake facilitate bowel elimination.

j. Which mechanical function of the bowel causes constipation?

4. You are a nurse in a medical-surgical hospital unit caring for a patient who had an open cholecystectomy 3 days earlier. Subsequently, the patient developed a paralytic ileus. Additional complications require continued postoperative antibiotic infusions.

a. What nursing assessment finding could indicate the presence of a paralytic ileus?

b. Which medical interventions could have contributed to the development of your patient’s paralytic ileus?

c. How long would you expect the paralytic ileus to last?

d. In what ways would you expect a paralytic ileus to resolve?

e. List possible nursing diagnoses for this patient related to the surgical procedure and postoperative complications.

Case Study: Death and dying- Read and review Chapter 43- (Loss, Grief, & Dying).

Simulation Scenario: Patient is wheezing, Sats drop to 89%, skin is mottled, patient is full code. You will need to apply oxygen and titrate the amount of oxygen up from nasal cannula, to simple face mask, to non-rebreather mask. You will then give an S.B.A.R. report to the provider. You will administer a nebulizer treatment. While the nebulizer is going, your patient’s family has a care conference with palliative care providers and they decide to back off on aggressive cares and move to a comfort care approach. You will need to use what you learned in Chapter 43- Loss, Grief, and dying along with other resources to alter your plan of care for your patient once the family and patient have decided to switch to comfort care.

Review the signs of impending death. Review the likely goals a person will have when changing from acute care to hospice/comfort care or palliative care according to Maslow’s Hierarchy of Needs.

What is the difference between hospice and palliative care? ___________________________________________________________ ______________________________________________________________________________________________________________________

What happens physiologically in each major body system when a person dies? _____________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What are the rights of a dying person?

____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

“It is well within the scope of your professional practice as a competent nurse to provide counseling and death education, especially when the patient asks for it and indicates an unmet need for such information” (Taylor, Lillis & Lynn, 2015, p. 1618).

When should you call in family and notify them of impending death?

What is involved in post-mortem care?

Caring for the body- _______________________________________________________________________________________________________________________________________________________________________________________________

Caring for the family- _____________________________________________________________________________________________________________________________________________________

Discussion: Medical Conditions

Read the description of the activity below:

Choose and describe a medical condition from any of the specialties (it can be a condition not covered in the book) that you have had or known someone that has had. Then use at least 10 medical terms (underline them) associated with this condition as you describe the condition, diagnosis, medical specialists/specialty associated with the condition, medications, treatments, etc…  You may need to use resources other than the textbook for accuracy, but paraphrase… please don’t just “cut & paste” (internet, other textbooks, etc…). Please cite your sources.